Abstract
Background: Awake craniotomy with intraoperative electrical mapping is a reliable method to minimize the risk of permanent deficit during surgery for low-grade glioma located within eloquent areas classically considered inoperable. However, it could be argued that preservation of functional sites might lead to a lesser degree of tumor removal. To the best of our knowledge, the extent of resection has never been directly compared between traditional and awake procedures. Objective: We report for the first time a series of patients who underwent 2 consecutive surgeries without and with awake mapping. Methods: Nine patients underwent surgery for a low-grade glioma in functional sites under general anesthesia in other institutions. The resection was subtotal in 3 cases and partial in 6 cases. There was a postoperative worsening in 3 cases. We performed a second surgery in the awake condition with intraoperative electrostimulation. The resection was performed according to functional boundaries at both the cortical and subcortical levels. Results: Postoperative magnetic resonance imaging showed that the resection was complete in 5 cases and subtotal in 4 cases (no partial removal) and that it was improved in all cases compared with the first surgery (P = .04). There was no permanent neurological worsening. Three patients improved compared with the presurgical status. All patients returned to normal professional and social lives. Conclusion: Our results demonstrate that awake surgery, known to preserve the quality of life in patients with low-grade glioma, is also able to significantly improve the extent of resection for lesions located in functional regions.
| Original language | English |
|---|---|
| Pages (from-to) | 1074-1084 |
| Number of pages | 11 |
| Journal | Neurosurgery |
| Volume | 66 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - Jun 2010 |
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Keywords
- Awake surgery
- Direct electrical stimulation
- Functional brain mapping
- Low-grade glioma
ASJC Scopus subject areas
- Clinical Neurology
- Surgery
Cite this
Awake mapping optimizes the extent of resection for low-grade gliomas in eloquent areas. / De Benedictis, Alessandro; Moritz-Gasser, Sylvie; Duffau, Hugues.
In: Neurosurgery, Vol. 66, No. 6, 06.2010, p. 1074-1084.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Awake mapping optimizes the extent of resection for low-grade gliomas in eloquent areas
AU - De Benedictis, Alessandro
AU - Moritz-Gasser, Sylvie
AU - Duffau, Hugues
PY - 2010/6
Y1 - 2010/6
N2 - Background: Awake craniotomy with intraoperative electrical mapping is a reliable method to minimize the risk of permanent deficit during surgery for low-grade glioma located within eloquent areas classically considered inoperable. However, it could be argued that preservation of functional sites might lead to a lesser degree of tumor removal. To the best of our knowledge, the extent of resection has never been directly compared between traditional and awake procedures. Objective: We report for the first time a series of patients who underwent 2 consecutive surgeries without and with awake mapping. Methods: Nine patients underwent surgery for a low-grade glioma in functional sites under general anesthesia in other institutions. The resection was subtotal in 3 cases and partial in 6 cases. There was a postoperative worsening in 3 cases. We performed a second surgery in the awake condition with intraoperative electrostimulation. The resection was performed according to functional boundaries at both the cortical and subcortical levels. Results: Postoperative magnetic resonance imaging showed that the resection was complete in 5 cases and subtotal in 4 cases (no partial removal) and that it was improved in all cases compared with the first surgery (P = .04). There was no permanent neurological worsening. Three patients improved compared with the presurgical status. All patients returned to normal professional and social lives. Conclusion: Our results demonstrate that awake surgery, known to preserve the quality of life in patients with low-grade glioma, is also able to significantly improve the extent of resection for lesions located in functional regions.
AB - Background: Awake craniotomy with intraoperative electrical mapping is a reliable method to minimize the risk of permanent deficit during surgery for low-grade glioma located within eloquent areas classically considered inoperable. However, it could be argued that preservation of functional sites might lead to a lesser degree of tumor removal. To the best of our knowledge, the extent of resection has never been directly compared between traditional and awake procedures. Objective: We report for the first time a series of patients who underwent 2 consecutive surgeries without and with awake mapping. Methods: Nine patients underwent surgery for a low-grade glioma in functional sites under general anesthesia in other institutions. The resection was subtotal in 3 cases and partial in 6 cases. There was a postoperative worsening in 3 cases. We performed a second surgery in the awake condition with intraoperative electrostimulation. The resection was performed according to functional boundaries at both the cortical and subcortical levels. Results: Postoperative magnetic resonance imaging showed that the resection was complete in 5 cases and subtotal in 4 cases (no partial removal) and that it was improved in all cases compared with the first surgery (P = .04). There was no permanent neurological worsening. Three patients improved compared with the presurgical status. All patients returned to normal professional and social lives. Conclusion: Our results demonstrate that awake surgery, known to preserve the quality of life in patients with low-grade glioma, is also able to significantly improve the extent of resection for lesions located in functional regions.
KW - Awake surgery
KW - Direct electrical stimulation
KW - Functional brain mapping
KW - Low-grade glioma
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U2 - 10.1227/01.NEU.0000369514.74284.78
DO - 10.1227/01.NEU.0000369514.74284.78
M3 - Article
VL - 66
SP - 1074
EP - 1084
JO - Neurosurgery
JF - Neurosurgery
SN - 0148-396X
IS - 6
ER -