Awake Surgery With Visual Pathway Mapping in Low Grade Glioma Surgery

Area of Science:

• Neuroscience
• Neurosurgery
• Ophthalmology

Background:

• The visual pathway's correlation with temporal lobe lesions is well-documented for epilepsy and trauma.
• However, its relationship with neoplastic lesions and subsequent decision-making remains less explored.

Observation:

• A 28-year-old male presented with seizures and left superior homonymous quadrantanopia.
• MRI revealed a right temporal lesion disrupting the visual pathway, confirmed by diffusion tensor imaging tractography.

Findings:

• Awake surgery with direct cortical electrostimulation of visual pathways enabled subtotal resection of a fibrillary astrocytoma.
• Postoperative MRI confirmed preserved visual function, demonstrating the efficacy of the surgical technique.

Implications:

• Intraoperative mapping of visual pathways is crucial for preserving function during surgery for gliomas in eloquent areas.
• This case provides a practical guideline for neurosurgeons managing complex cases involving visual pathway compromise.