gms | German Medical Science

60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit den Benelux-Ländern und Bulgarien

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

24. - 27.05.2009, Münster

Lessons to be learned from intraopeative mapping of language pathways in patients with Grade II glioma in the left dominant hemisphere

Meeting Abstract

  • T. Kombos - Neurochirurgische Klinik, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin
  • T. Picht - Neurochirurgische Klinik, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin
  • N. Hecht - Neurochirurgische Klinik, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin
  • P. Vajkoczy - Neurochirurgische Klinik, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin
  • O. Suess - Neurochirurgische Klinik, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocMO.05-06

DOI: 10.3205/09dgnc023, URN: urn:nbn:de:0183-09dgnc0239

Veröffentlicht: 20. Mai 2009

© 2009 Kombos 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 vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Intraoperative mapping of language pathways has become an established procedure in patients operated on for tumours in the language cortical areas. The treatment of low grade gliomas is still a challenge especially in eloquent areas.

Methods: A total of 45 patients with low-grade gliomas in the dominant hemisphere underwent awake craniotomy and mapping of language pathways. Functional MRI was performed preoperatively in all cases. Surgery was performed following a standardised protocol. Following craniotomy under anaesthesia and sedation without pin fixation of the head, cortical language mapping was performed in the fully co-operative patient. Depending on the functional data and the individual operative risk tumour resection then proceeded either under conscious sedation with the option of subcortical language monitoring or under general anaesthesia.

Results: Total tumour resection, as verified in early postoperative MRI, was achieved in 36 patients. In 8 patients a cross total resection and in one case only a biopsy was performed. Surgery under local anaesthesia with consecutive subcortical mapping was performed in 37 patients. In three cases intraoperative testing was not optimal, due to preexisting speech disturbances. Functional areas were located within the tumour in five cases. In the remaining the functional areas were shifted on the tumour borders. In cases with a pre-existing speech disturbance, according to the Aachener Aphasie Test, speech function deteriorated in the first 48 hours und improved to normal after 6 weeks. In cases with normal preoperative speech function postoperative language was also normal.

Conclusions: Intraoperative cortical and subcortical mapping is a useful tool during surgery in eloquent cortical areas. Especially during surgery for low-grade gliomas a tailored made resection can be performed. It is possible to study the individual organization of language networks and therefore optimise the benefit-to-risk ratio of surgery for low-grade gliomas in the dominant hemisphere. However, selection of patients remains a problem.