Intraoperative electrical stimulation in awake craniotomy: methodological aspects of current practice

Area of Science:

• Neurosurgery
• Neuro-oncology
• Neurophysiology

Background:

• Extent of tumor resection in low-grade glioma surgery correlates with patient survival.
• Achieving maximal tumor removal without causing permanent neurological deficits presents a significant surgical challenge.
• Electrical brain stimulation during awake craniotomy is crucial for mapping critical brain functions near gliomas.

Purpose of the Study:

• To provide an overview of current brain mapping techniques for sensorimotor, language, and cognitive functions in awake surgery for low-grade glioma.
• To aid neurosurgeons, neurophysiologists, linguists, and anesthesiologists in understanding and comparing these stimulation techniques.
• To guide practitioners new to the field of intraoperative brain mapping for glioma surgery.

Main Methods:

• Literature review on brain stimulation techniques for low-grade glioma surgery.
• Discussions within the European Low-Grade Glioma Group.
• Analysis of clinical experience and illustrative cases.

Main Results:

• Detailed overview of stimulation techniques for mapping sensorimotor, language, and cognitive functions.
• Emphasis on the importance of electrical stimulation in conjunction with awake craniotomy.
• Identification of critical cortical and axonal areas within or adjacent to the tumor.

Conclusions:

• Electrical brain stimulation is an essential tool for optimizing tumor resection in low-grade glioma surgery.
• Understanding and standardizing these mapping techniques can improve surgical outcomes and facilitate research.
• This overview serves as a guide for improving patient survival and neurological function preservation.