Digital tool for monitoring cognitive function in awake brain tumor surgery

To ensure that cognitive function (language, memory, etc.) is maintained in connection with the removal of a brain tumor, the surgery is sometimes performed while the patient is awake. In this project, we are developing hardware and software for improving the testing of these functions.

The first-hand choice of treatment for patients with brain tumours is a neurosurgical operation, a resection, which involves removing as much as possible of the tumour tissue, followed by radiation and chemotherapy. 

In tumour resection cases where the tumour resides in (or near) distinctly sensitive areas, a particularly difficult consideration needs to be taken. The more of the tumour that can be removed, the better the chances of survival, which is why maximum resection is aspired. At the same time, there is a risk that an overly extensive resection might cause difficulties with cognitive functions such as language, planning ability and memory. 

To remove as much of the tumor as possible while minimizing the risk of the resection damaging cognitive function, this type of surgery is performed while the patient is awake. 

During the operation, the patient's cognitive function (e.g. language function and memory) is monitored with the help of conversations and neuropsychological tests. The neurosurgeon can keep removing as much tumor as possible, until the results of the test show that further resection risks damaging the patient's cognitive function in a way that can be disabling in everyday life. 

In this project, we are developing a method for testing cognitive function during awake surgery in a more comprehensive way than before. On one hand, we are working to find hardware that can enable more comprehensive testing. Currently, we are finding a way to mirror the patient’s screen on a pair of "smart" glasses worn by the test leader, which will simplify the evaluation of the patient's response. On the other hand, we are developing protocols with various neuropsychological tests that can be used with the above-mentioned hardware during operations. 

By evaluating the cognitive function more comprehensively (an increased number of sessions during surgery as well as evaluation of several cognitive domains), we expect to be able to further improve our ability in finding the balance between maximum resection of tumour and maintained cognitive function. 

Mattias Stålnacke 
Doctoral student and project owner, leg. psychologist, specialized in clinical neuropsychology  

Project group at MT-FoU: