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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 brain surgery using intraoperative brain stimulation (ioBS) for supratentorial cavernoma (SCA) in eloquent areas improves resection rates. This technique minimizes neurological deficits and enhances seizure control, leading to better patient outcomes.
Area of Science:
- Neurosurgery
- Neurology
- Neuroscience
Background:
- Symptomatic supratentorial cavernoma (SCA) resection is crucial to prevent seizures and rebleeding.
- Surgery in eloquent brain areas carries risks of neurological deficits.
- Intraoperative brain stimulation (ioBS) in awake patients is explored for SCA removal.
Purpose of the Study:
- To assess the feasibility of awake surgery for SCAs in eloquent areas using ioBS.
- To evaluate the extent of tumor resection and patient outcomes.
- To determine the impact of ioBS on minimizing neurological morbidity.
Main Methods:
- Six patients with symptomatic SCAs in eloquent areas underwent awake surgery with ioBS.
- Preoperative neuropsychological assessments covered language, sociocognitive, and executive functions.
- Intraoperative ioBS guided resection, with postoperative MRI and 6-month neuropsychological follow-up.
Main Results:
- Complete 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 improved significantly, discontinuing antiepileptic drugs.
Conclusions:
- Awake surgery with ioBS is feasible for symptomatic SCAs in eloquent areas.
- ioBS increases complete resection rates while minimizing neurological and neuropsychological deficits.
- This approach improves seizure control and overall patient outcomes.
