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Published on: August 12, 2019
Intraoperative brain mapping during awake surgery in symptomatic supratentorial cavernomas.
Ricardo Prat-Acín1, Inma Galeano-Senabre1, Pilar López-Ruiz2
1Servicio de Neurocirugía. Hospital Universitario I Politècnic La Fe, Valencia, Spain; Unidad Mixta Nanomedicina y Sensores: Fundación Hospital La Fe, Universidad Politécnica de Valencia, Spain.
Awake surgery using intraoperative brain stimulation (ioBS) for supratentorial cavernoma (SCA) in eloquent areas improves complete resection rates. This technique minimizes neurological deficits and enhances seizure control in patients with brain cavernomas.
Area of Science:
- Neurosurgery
- Neurology
- Neuroscience
Background:
- Complete resection of symptomatic supratentorial cavernoma (SCA) is crucial for preventing seizures and rebleeding.
- Surgery in eloquent brain areas carries a high risk of neurological deficits.
- Intraoperative brain stimulation (ioBS) in awake patients is explored for safer SCA removal.
Purpose of the Study:
- To assess the feasibility of surgical removal of SCAs in eloquent areas using awake craniotomy with ioBS.
- To evaluate the extent of tumor resection and patient outcomes, including neurological and neuropsychological function.
- To determine the impact of ioBS on seizure control post-surgery.
Main Methods:
- Six patients with symptomatic SCAs in eloquent areas underwent awake surgery with local anesthesia and ioBS.
- Preoperative neuropsychological assessments covered language, sociocognitive, and executive functions.
- Intraoperative ioBS guided surgical resection, with postoperative MRI assessing resection extent and 6-month follow-up for neuropsychological status.
Main Results:
- Complete surgical resection was achieved in 5 out of 6 patients.
- Transient deficits (hemiparesis, dysnomia) occurred in two patients, resolving within 6 months.
- All patients recovered from preoperative symptoms; 5 with seizures showed significant improvement, discontinuing antiepileptic drugs.
Conclusions:
- Intraoperative brain stimulation in awake surgery for SCAs in eloquent areas increases complete resection rates.
- This technique effectively minimizes postoperative neurological and neuropsychological deficits.
- Awake surgery with ioBS improves seizure control in patients with brain cavernomas.
