Addressing connectomic constraints in early practice of awake-guided neurosurgery: a four-year prospective case-matched analysis.
Identification of the inferior fronto-occipital fasciculus was lower in early-career surgeons' mapping.
Addressing connectomic constraints in early practice of awake-guided neurosurgery: a four-year prospective case-matched analysis.
The learning curve associated with mastering white matter tracts (white matter tracts) identification using direct electrostimulation (direct electrostimulation) mapping remains poorly characterized.
The goal of this study was to compare subcortical direct electrostimulation mapping performance between early-career and expert neurosurgeons.
In this prospective, monocentric, case-matched study, patients undergoing awake functional-guided resection (2022-2025) were operated on either by an early-career neurosurgeon during the first four years of independent practice (cohort A ) or by a senior expert neurosurgeon with extensive experience in awake mapping procedures (cohort B ).
early-career surgeons found this tract less often than experts, especially from the left frontal side
Histology differed between cohorts, with fewer IDH-mutant grade 2 gliomas (46.5% vs 65.3%) and more glioblastomas (27.7% vs 6.4%) in cohort A .
Postoperative tumor volume and functional outcomes were comparable.
Negative motor responses were more frequent in cohort A (+ 11.3%[95%CI:3.3-18.9], P = 0.006), whereas semantic paraphasia tended to be less frequent (- 15.4%[95%CI: - 32.3-0.6], P = 0.079).
Benchmarking early-career practice of awake functional-guided resection against expert practice reveals selective, tract- and functional system-specific differences in direct electrostimulation mapping strategies, with minimal impact on EOR and similar functional outcomes.
These findings suggest that awake functional-guided resection is reliably implementable during early independent practice and support a dynamic connectomic constraint framework to guide training.