"Next Door" intraoperative magnetic resonance imaging for awake craniotomy: Preliminary experience and technical note

Abstract

Background:During glioma surgery “maximal safe resection” must be the main goal. Intraoperative magnetic resonance imaging (iMRI) associated with awake craniotomy (AC) is a valuable tool to achieve this objective. In this article, AC with a “next-door” iMRI concept is described in a stepwise protocol.Methods:This is a retrospective analysis of 18 patients submitted to AC using iMRI; a stepwise protocol is also discussed.Results:The mean age was 41.7 years. Hemiparesis, aphasia, and seizures were the main initial symptoms of the patients. Sixty-six percent of the tumors were located in the left hemisphere. All tumors were near or within eloquent areas. Fifty-three percent of the cases were glioblastomas multiforme and 47% of the patients had low grade gliomas. The mean surgical time and iMRI time were 4 h 4 min and 30 min, respectively. New resection was performed in 33% after iMRI. Extent of resection (EOR) higher than 95% was possible in 66.7% of the patients. The main reason of EOR lower than 95% was positive mapping of eloquent areas (6 patients). Eighty percent of the patients experienced improvement of their deficits immediately after the surgery or had a stable clinical status whereas 20% had neurological deterioration, however, all of them improved after 30 days.Conclusion:AC associated with “next-door” iMRI is a complex procedure, but if performed using a meticulous technique, it may improve the overall tumor resection and safety of the patients.

Resection of high-grade glioma involving language areas assisted by multimodal techniques under general anesthesia: a retrospective study

“…We thought the reason was that some studies did not only include GILAs but also may include gliomas of other eloquent areas. Such as Peruzzi 2011 [ 53 ], Pichierri 2019 [ 54 ], Tuominen 2013 [ 59 ], Ghinda 2016 [ 38 ], Mathias 2016 [ 46 ], Maldaun 2014 [ 45 ], Motomura 2017 [ 47 ] and Leon-Rojas 2020 [ 43 ], although these studies reported the incidences of TLD and PLD, the results may not reflect the real incidences because the inclusion of gliomas of other eloquent areas. The median PFS and OS of our cohort was longer than those of most cohorts in previous studies.…”

Monopolar 250–500 Hz language mapping: Results of 41 patients

“…To assess the efficacy of the chosen method, we should observe its effect on adjacent tissue ( Ritaccio et al, 2018 ). Concerning speech tests, positive effects are expressed, for example, by anomalies in figure identification, speech arrest, aphasia, dysphasia, reverberation, and phonetic, phonemic or semantic paraphasia ( Bello et al, 2014 , Benzagmout et al, 2007 , Chang et al, 2015 , Duffau, 2011 , Duffau, 2015 , Hamer et al, 2012 , Mandonnet et al, 2017 , Mathias et al, 2016 , Ojemann and Whitaker, 1978 , Picht et al, 2013 , Riva et al, 2015 ). The effect ceases when the electrical stimulus is stopped.…”

“…Cortical mapping has greatly improved the outcome of brain surgeries. ( Beez et al, 2013 , Benzagmout et al, 2007 , Chang et al, 2015 , Duffau, 2010 , Duffau, 2011 , Hamer et al, 2012 , Mandonnet et al, 2017 , Mathias et al, 2016 ). The main goal in glioma surgeries is to try to achieve gross resection with as much safety as possible.…”