Awake craniotomy and electrophysiological mapping for eloquent area tumours

Abstract Objective An awake craniotomy facilitates radical excision of eloquent area gliomas and ensures neural integrity during the excision. The study describes our experience with 67 consecutive awake craniotomies for the excision of such tumours. Methods Sixty-seven patients with gliomas in or a...

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Bibliographic Details
Published in:Clinical neurology and neurosurgery 2013-03, Vol.115 (3), p.329-334
Main Authors: Chacko, Ari George, Thomas, Santhosh George, Babu, K. Srinivasa, Daniel, Roy Thomas, Chacko, Geeta, Prabhu, Krishna, Cherian, Varghese, Korula, Grace
Format: Article
Language:English
Subjects:
Adolescent
Adult
Age
Anesthesia
Awake craniotomy
Brain Mapping - methods
Brain Mapping - mortality
Brain Neoplasms - diagnostic imaging
Brain Neoplasms - mortality
Brain Neoplasms - pathology
Brain tumors
Conflicts of interest
Cortex
Cortex (motor)
Cortical mapping
Craniotomy - methods
Craniotomy - mortality
Electric Stimulation
Electrophysiology
Eloquent
Female
Glioma
Humans
Intraoperative Complications - diagnosis
Language
Language Tests
Magnetic Resonance Imaging
Male
Mapping
Middle Aged
Monitoring, Intraoperative
Motor Cortex - pathology
Nervous System Diseases - etiology
Neurological diseases
Neurology
Neurosurgery
Patients
Postoperative Complications - diagnosis
Postoperative deficit
Prefrontal Cortex - pathology
Radicals
Substantia alba
Surgery
Tumors
Ultrasonography
Wakefulness
Wounds
Young Adult
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Summary:Abstract Objective An awake craniotomy facilitates radical excision of eloquent area gliomas and ensures neural integrity during the excision. The study describes our experience with 67 consecutive awake craniotomies for the excision of such tumours. Methods Sixty-seven patients with gliomas in or adjacent to eloquent areas were included in this study. The patient was awake during the procedure and intraoperative cortical and white matter stimulation was performed to safely maximize the extent of surgical resection. Results Of the 883 patients who underwent craniotomies for supratentorial intraaxial tumours during the study period, 84 were chosen for an awake craniotomy. Sixty-seven with a histological diagnosis of glioma were included in this study. There were 55 men and 12 women with a median age of 34.6 years. Forty-two (62.6%) patients had positive localization on cortical stimulation. In 6 (8.9%) patients white matter stimulation was positive, five of whom had responses at the end of a radical excision. In 3 patients who developed a neurological deficit during tumour removal, white matter stimulation was negative and cessation of the surgery did not result in neurological improvement. Sixteen patients (24.6%) had intraoperative neurological deficits at the time of wound closure, 9 (13.4%) of whom had persistent mild neurological deficits at discharge, while the remaining 7 improved to normal. At a mean follow-up of 40.8 months, only 4 (5.9%) of these 9 patients had persistent neurological deficits. Conclusion Awake craniotomy for excision of eloquent area gliomas enable accurate mapping of motor and language areas as well as continuous neurological monitoring during tumour removal. Furthermore, positive responses on white matter stimulation indicate close proximity of eloquent cortex and projection fibres. This should alert the surgeon to the possibility of postoperative deficits to change the surgical strategy. Thus the surgeon can resect tumour safely, with the knowledge that he has not damaged neurological function up to that point in time thus maximizing the tumour resection and minimizing neurological deficits.
ISSN:0303-8467
1872-6968
DOI:10.1016/j.clineuro.2012.10.022