gms | German Medical Science

57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

11. bis 14.05.2006, Essen

Surgery for tumors around language areas

Meeting Abstract

  • corresponding author K. Sakurada - Department of Neurosurgery, Yamagata University School of Medicine, Yamagata, Japan
  • T. Kayama - Department of Neurosurgery, Yamagata University School of Medicine, Yamagata, Japan
  • S. Saito - Department of Neurosurgery, Yamagata University School of Medicine, Yamagata, Japan
  • S. Sato - Department of Neurosurgery, Yamagata University School of Medicine, Yamagata, Japan
  • M. Saino - Department of Neurosurgery, Yamagata University School of Medicine, Yamagata, Japan
  • S. Takemura - Department of Neurosurgery, Yamagata University School of Medicine, Yamagata, Japan
  • A. Kuge - Department of Neurosurgery, Yamagata University School of Medicine, Yamagata, Japan

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocFR.11.05

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2006/06dgnc073.shtml

Veröffentlicht: 8. Mai 2006

© 2006 Sakurada et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

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Objective: We reported our cortical mapping methods and surgical strategies in awake surgery for tumors around language area.

Methods: Preoperative functional MRI and/or Wada test are essential to surgery for the tumors around inferior frontal gyrus or superior temporal gyrus, because the language-dominant hemisphere must be clear before surgery. In case that tumor seems to be around the language area, a patient is a candidate for awake surgery. Awake surgery is performed under general anesthesia by propofol with local anesthesia along skin incision. After craniotomy, a patient is waked up by stopping propofol injection. Cortical mapping is performed by evaluation of language dysfunction during cortical stimulation (bipolar stimulation: 4-10mA, 50c/s, 0.2ms) under monitoring of electro-corticogram (EcoG). Picture naming and reading of Chinese and Japanese characters are usually used as language tasks. After this cortical mapping, the patient is anesthetized again by continuous injection of propofol. And then the tumor is resected avoiding language area. Even if a lesion is just under the language cortex, the tumor may be resectable by trans-sylvian approach. Because of our recent study about language function of cortices facing the sylvian fissure,it became apparent that they have no language function. Of course, another cortical mapping in sylvian fissure is needed in this case.

Results: In the last 8 years, 21 awake surgeries were performed for tumors around language areas. As a result, macroscopic total resection was performed in ten cases without any morbidities. In only one case, in which the tumor invaded the language area, the tumor was resected partially sparing his language function. Among these 21 awake surgeries, the trans-sylvian approach was used for five cases.

Conclusions: Cortical mapping of the language area using awake surgery is quite effective and important to maintain the language function for the surgery of tumors around the language area.