Awake surgery for glioma resection in eloquent areas—Zurich's experience and review—

Naoki Otani, Miroslava Bjeljac, Carl Muroi, Dorothea Weniger, Nadia Khan, Heinz-Gregor Wieser, Marijan Curcic, Yasuhiro Yonekawa
Neurologia Medico-chirurgica 2005, 45 (10): 501-10; discussion 510-1
Awake surgery was performed in a series of 21 patients with gliomas in eloquent areas with the use of intraoperative electrical mapping. Gross total removal was performed in 18 patients. There was no operative mortality. Postoperative findings included no change in symptoms and signs in 10 patients, improvement of the preoperative deficit in 11 patients. Four patients had improved Karnofsky performance status (KPS) scores after surgery, 17 patients were stable, and no patient had lower KPS score. Extensive radical resection of gliomas prolongs the overall survival and improves the patient's quality of life. However, surgical resection of gliomas located within the sensorimotor or language areas remains a neurosurgical challenge in reducing eloquent neurological sequelae. Awake surgery with intraoperative functional mapping is a safe approach to maximize the extent of tumor removal and to minimize the resultant neurological deficits in the treatment of glioma involving the eloquent cortex.

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