P10.05 Establishment of team work awake craniotomy: clinical experience in Taiwan

Abstract

Abstracts iii86NEURO-ONCOLOGY • MAY 2017 able whether bevacizumab can have a therapeutic effect in patients with these tumors. However, the development of nodular, necrotic and/or contrast-enhancing lesions in patients with a gliomatosis cerebri pattern is not uncommon and may indicate active neo-angiogenesis. Therefore, control of growth of these lesions as well as control of edema and reduction of steroid use may be viewed as rationales for the use of bevacizumab in these patients. In this patient series, we report on seventeen patients with primary brain tumors and a gliomatosis cerebri growth pattern (seven glioblastoma WHO°IV, two anaplastic astrocytoma WHO°III, one anaplastic oligodendroglioma WHO°III, seven astrocytoma WHO°II) treated with bevacizumab alone or in combination with lomustine or irinotecan. We found bevacizumab to be active with response rates, progression-free survival and overall survival intervals comparable to a control cohort of patients with gliomas of a less infiltrative phenotype. Based on these results, anti-angiogenic therapy with bevacizumab should also be considered in patients suffering from gliomas of a mainly infiltrative phenotype. INTRODUCTION: Awake craniotomy provides the opportunity to maximize both extent of resection and preservation of neurological function. Serial preoperative and postoperative neurobehavial evaluation, magnetic resonance image examination and intraoperative task investigation need multidisciplinary experts to cooperate. MATERIALS AND METHODS: From 2013, we gradually establish our team for awake craniotomy. Patient who had brain tumor with the symptom of aphasia or hemiparesis and are willing to cooperate would be entered the protocol of awake craniotomy. Patients would receive complete preoperative neurobehavial examination by psychologists and speech therapists and magnetic resonance image included diffuse tensor image. During operation, Patients went through asleepawake-asleep anesthetic techniques. Direct electric stimulation was used for both cortical and subcortical mapping. Navigation included information of lesion and important fiber tract guided the direction of excision. Rehabilitation doctor performed the tasks and decided the positive response caused by stimulation or excisional procedure. After operation, post-operative image and neurobehavial examination would be performed within one week, 3 months, 6 months and one year later RESULTS: We scheduled awake craniotomy on almost every Tuesday. In recent 89 patients who received awake craniotomy, Twenty-five participants with recurrent tumor underwent the operation. Seven patients received twice and one patient received three times of awake craniotomy. Two patients had controllable intraoperative seizure attack. Early termination of awake status was found in two patients due to general discomfort. Patients with modest preoperative performance status still benefit from the operation. Neurobehavioral functions improved over time and some specific feature correlate to certain aspect of qualit...