Intraoperative Assessment of Right Cingulum Function Using the Williams Inhibition Test During Awake Surgery for Right Frontal Gliomas.

Objectives: The cingulum is crucial for cognitive control and functionally relevant in various neurological diseases, including brain tumors. This study evaluated the usefulness of the Williams Inhibition Test (WIT), a Stroop-like task reflecting non-verbal cognitive control, in assessing cingulum function during awake surgery for right frontal gliomas.

Methods: In this retrospective study, data from 46 patients with World Health Organization grade 2 or 3 right frontal gliomas who underwent awake surgery were analyzed. WIT was administered intraoperatively to monitor cingulum function. Patients were categorized into WIT and non-WIT groups, the latter consisting primarily of historical controls. We examined the anatomical location of positive WIT mappings and compared tumor resection extent, Karnofsky Performance Status (KPS), and neurocognitive outcomes between groups.

Results: No significant preoperative differences were observed between groups. Positive WIT mappings were identified in 35.7% of the WIT group, primarily along the cingulum trajectory. Resection extent was comparable between groups. At 3 months postoperatively, the WIT group showed significantly higher KPS (p = 0.012) and better neurocognitive performance than the non-WIT group in the Trail Making Test (p = 0.042). Additionally, the TMT score improved significantly after surgery only in the WIT group (p = 0.016).

Conclusions: Intraoperative use of WIT may aid in identifying functional cingulum regions and is associated with better neurocognitive outcomes and comparable resection rates. These findings suggest that WIT may be a useful tool for monitoring cognitive control function during awake surgery for right frontal gliomas.