Awake craniotomy for gliomas in a high-field intraoperative magnetic resonance imaging suite: analysis of 42 cases

Abstract

Object. The object of this study was to describe the experience of combining awake craniotomy techniques with high-field (1.5 T) intraoperative MRI (iMRI) for tumors adjacent to eloquent cortex.Methods. From a prospective database the authors obtained and evaluated the records of all patients who had undergone awake craniotomy procedures with cortical and subcortical mapping in the iMRI suite. The integration of these two modalities was assessed with respect to safety, operative times, workflow, extent of resection (EOR), and neurological outcome.Results. Between February 2010 and December 2011, 42 awake craniotomy procedures using iMRI were performed in 41 patients for the removal of intraaxial tumors. There were 31 left-sided and 11 right-sided tumors. In half of the cases (21 [50%] of 42), the patient was kept awake for both motor and speech mapping. The mean duration of surgery overall was 7.3 hours (range 4.0-13.9 hours). The median EOR overall was 90%, and gross-total resection (EOR ≥ 95%) was achieved in 17 cases (40.5%). After viewing the first MR images after initial resection, further resection was performed in 17 cases (40.5%); the mean EOR in these cases increased from 56% to 67% after further resection. No deficits were observed preoperatively in 33 cases (78.5%), and worsening neurological deficits were noted immediately after surgery in 11 cases (26.2%). At 1 month after surgery, however, worsened neurological function was observed in only 1 case (2.3%).Conclusions. There was a learning curve with regard to patient positioning and setup times, although it did not adversely affect patient outcomes. Awake craniotomy can be safely performed in a high-field (1.5 T) iMRI suite to maximize tumor resection in eloquent brain areas with an acceptable morbidity profile at 1 month. (http://thejns.org/doi/abs/10.3171/2014.6.JNS132285) Key words • awake craniotomy • cortical mapping • glioma surgery • iMRI • EOR • oncologyAbbreviations used in this paper: DTI = diffusion tensor imaging; DWI = diffusion-weighted imaging; EOR = extent of resection; fMRI = functional MRI; GTR = gross-total resection; iMRI = intraoperative MRI; LMA = laryngeal mask airway; OR = operating room; PR = partial resection; STR = subtotal resection.

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“…The rate of GTR achieved in our study is similar to the rates reported previously. 16,19,21,33,35 Although OS and PFS were different between the LGG and HGG groups, the relatively short observational period (a mean of 24.8 months) prevents us from making any definitive conclusion for the LGG group based on these results. Nonetheless, to our knowledge this is the first study to analyze the clinical outcomes, and the follow-up period is considerably longer than in the previous reports.…”

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“…The AC procedure was developed to allow greater resection with less risk of damaging eloquent cognitive brain functions [1,[13][14][15]. There is limited evidence regarding the best anesthesia technique for resecting these insular tumors, and the number of patients in published articles is relatively low.…”

Risco De Acidente Vascular Encefálico Em Mulheres Jovens Relacionado Ao Uso Do Contraceptivo Oral

“…Trata-se de equipamento intraoperatório presente apenas em centros de referência e com altos custos de realização. Ademais, há claras limitações técnicas como longo tempo necessário para aquisição de imagens, necessidade de técnicas anestésicas especiais, interferências instrumentais (Maldaun et al 2014).…”