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Awake craniotomy and electrophysiological mapping for eloquent area tumours
Ari George Chacko1, Santhosh George Thomas, K Srinivasa Babu
1Department of Neurological Sciences, Section of Neurosurgery, Christian Medical College, Vellore, Tamil Nadu, India.
Clinical Neurology and Neurosurgery
|November 27, 2012
Summary
Awake craniotomy allows safe removal of gliomas near critical brain areas by mapping function during surgery. This technique maximizes tumor resection while minimizing neurological deficits, improving patient outcomes.
Area of Science:
- Neurosurgery
- Oncology
- Neurology
Background:
- Eloquent area gliomas pose surgical challenges due to proximity to critical brain functions.
- Awake craniotomy is a technique to preserve neurological function during tumor resection.
Purpose of the Study:
- To describe the experience with awake craniotomy for glioma excision in eloquent areas.
- To evaluate the safety and efficacy of awake craniotomy in maximizing tumor resection and minimizing neurological deficits.
Main Methods:
- Sixty-seven patients with gliomas in or adjacent to eloquent areas underwent awake craniotomy.
- Intraoperative cortical and white matter stimulation was used for functional mapping and guiding surgical resection.
Main Results:
- Awake craniotomy was performed in 67 patients with gliomas.
- Cortical stimulation identified eloquent areas in 62.6% of patients.
- White matter stimulation identified critical pathways in 8.9% of patients, aiding in safe resection.
- Postoperative neurological deficits were observed in 24.6% of patients, with most showing improvement or mild persistent deficits at follow-up.
Conclusions:
- Awake craniotomy enables precise mapping of motor and language areas during glioma surgery.
- Continuous neurological monitoring and intraoperative stimulation help maximize tumor resection while preserving neurological function.
- Positive responses during white matter stimulation alert surgeons to potential risks, allowing for strategy adjustments to minimize postoperative deficits.
