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Updated: Jul 28, 2026
A Large Lateral Craniotomy Procedure for Mesoscale Wide-field Optical Imaging of Brain Activity
Published on: May 7, 2017
Awake craniotomy for aggressive resection of primary gliomas located in eloquent brain
F B Meyer1, L M Bates, S J Goerss
1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minn 55905, USA. meyer.fredric@mayo.edu
Objective:
To determine with intraoperative neurologic and language examinations the maximal tumor resection achievable with acceptable postoperative neurologic dysfunction in patients undergoing awake stereotactic glial tumor resection in eloquent regions of the brain.
Patients And Methods:
Between October 1995 and December 2000, 65 patients underwent frameless stereotactic resection of glial tumors located in functioning tissue. During the resection, continuous examinations by a neurologist and speech pathologist were performed. The goal of surgery was to resect the maximum neurologically permissible tumor volume defined on preoperative T2 imaging. Tumor resection was stopped at the onset of neurologic dysfunction. Novel segmentation software was used to measure tumor cytoreduction based on pre- and postoperative magnetic resonance imaging. All patients underwent 3-month postoperative neurologic examinations to determine functional outcomes.
Results:
The cortical and subcortical white matter tracts at risk for injury were the left frontal operculum in 15 patients, the central lobule in 38, the insula in 11, and the left angular gyrus in 1. Thirty-four (52%) had a greater than 90% reduction in T2 signal postoperatively. In 26 patients thought to have low-grade tumors based on preoperative imaging, 12 proved to have grade 3 gliomas. Forty-eight patients (74%) developed intraoperative deficits; 34 (71%) recovered to a modified Rankin grade of 0 or 1 at 3 months postoperatively, 11 (23%) achieved a modified Rankin grade of 2, and 3 patients (6%) achieved a modified Rankin grade of 3 or 4 at 3-month follow-up. There was no operative mortality; 17 patients (26%) died from tumor progression during the follow-up period.
Conclusions:
Combining frameless computer-guided stereotaxis with cortical stimulation and repetitive neurologic and language assessments facilitates tumor resection in functioning brain regions. Resecting tumor until the onset of neurologic deficits allows for a good functional recovery. Imaging software can objectively and accurately measure preoperative and postoperative tumor volumes.
Insights
Awake brain surgery using frameless stereotaxis and real-time monitoring allows maximal glial tumor resection in eloquent areas. This approach enables good functional recovery by stopping resection at the onset of neurologic deficits.
Area of Science:
- Neurosurgery
- Oncology
- Neurology
Background:
- Resection of glial tumors in eloquent brain regions poses challenges due to the risk of postoperative neurologic deficits.
- Maximal safe tumor resection is crucial for improving patient outcomes and survival.
Purpose of the Study:
- To evaluate the feasibility of maximal tumor resection with acceptable neurologic dysfunction using awake stereotactic glial tumor resection.
- To assess functional outcomes after awake craniotomy for brain tumors.
Main Methods:
- 65 patients with glial tumors in eloquent areas underwent frameless stereotactic resection.
- Intraoperative neurologic and language monitoring was performed continuously by a neurologist and speech pathologist.
- Novel segmentation software measured tumor volume reduction from pre- and postoperative MRI.
Main Results:
- 52% of patients achieved >90% T2 signal reduction postoperatively.
- 74% experienced intraoperative deficits, but 71% recovered to a modified Rankin grade of 0 or 1 at 3 months.
- No operative mortality occurred; 26% died from tumor progression during follow-up.
Conclusions:
- Frameless stereotaxis combined with intraoperative monitoring facilitates maximal tumor resection in eloquent brain regions.
- Resection guided by neurologic deficits allows for good functional recovery.
- Imaging software accurately quantifies tumor resection volumes.
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