Awake craniotomy and electrophysiological mapping for eloquent area tumours.

Details

Serval ID
serval:BIB_9A301EBD4BDB
Type
Article: article from journal or magazin.
Collection
Publications
Title
Awake craniotomy and electrophysiological mapping for eloquent area tumours.
Journal
Clinical Neurology and Neurosurgery
Author(s)
Chacko A.G., Thomas S.G., Babu K.S., Daniel R.T., Chacko G., Prabhu K., Cherian V., Korula G.
ISSN
1872-6968 (Electronic)
ISSN-L
0303-8467
Publication state
Published
Issued date
2013
Volume
115
Number
3
Pages
329-334
Language
english
Notes
Publication types: Journal ArticlePublication Status: ppublish
Abstract
OBJECTIVE: An awake craniotomy facilitates radical excision of eloquent area gliomas and ensures neural integrity during the excision. The study describes our experience with 67 consecutive awake craniotomies for the excision of such tumours.
METHODS: Sixty-seven patients with gliomas in or adjacent to eloquent areas were included in this study. The patient was awake during the procedure and intraoperative cortical and white matter stimulation was performed to safely maximize the extent of surgical resection.
RESULTS: Of the 883 patients who underwent craniotomies for supratentorial intraaxial tumours during the study period, 84 were chosen for an awake craniotomy. Sixty-seven with a histological diagnosis of glioma were included in this study. There were 55 men and 12 women with a median age of 34.6 years. Forty-two (62.6%) patients had positive localization on cortical stimulation. In 6 (8.9%) patients white matter stimulation was positive, five of whom had responses at the end of a radical excision. In 3 patients who developed a neurological deficit during tumour removal, white matter stimulation was negative and cessation of the surgery did not result in neurological improvement. Sixteen patients (24.6%) had intraoperative neurological deficits at the time of wound closure, 9 (13.4%) of whom had persistent mild neurological deficits at discharge, while the remaining 7 improved to normal. At a mean follow-up of 40.8 months, only 4 (5.9%) of these 9 patients had persistent neurological deficits.
CONCLUSION: Awake craniotomy for excision of eloquent area gliomas enable accurate mapping of motor and language areas as well as continuous neurological monitoring during tumour removal. Furthermore, positive responses on white matter stimulation indicate close proximity of eloquent cortex and projection fibres. This should alert the surgeon to the possibility of postoperative deficits to change the surgical strategy. Thus the surgeon can resect tumour safely, with the knowledge that he has not damaged neurological function up to that point in time thus maximizing the tumour resection and minimizing neurological deficits.
Keywords
Adolescent, Adult, Anesthesia, Brain Mapping/methods, Brain Mapping/mortality, Brain Neoplasms/mortality, Brain Neoplasms/pathology, Craniotomy/methods, Craniotomy/mortality, Electric Stimulation, Electrophysiology, Female, Humans, Intraoperative Complications/diagnosis, Language Tests, Magnetic Resonance Imaging, Male, Middle Aged, Monitoring, Intraoperative, Motor Cortex/pathology, Nervous System Diseases/etiology, Postoperative Complications/diagnosis, Prefrontal Cortex/pathology, Wakefulness, Young Adult
Pubmed
Web of science
Create date
04/02/2014 13:58
Last modification date
20/08/2019 15:01
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