gms | German Medical Science

Objective: Awake craniotomy is an established method in Low Grad Glioma (LGG) surgery in case of tumor location in or close proximity to language areas or pathways. Aim of the present study was whether high grade glioma (HGG) patients with tumors in eloquent regions benefit in a similar way from tumor resection undergoing awake surgery?

Methods: The data for this study derive from a prospectively conducted series of cerebral gliomas undergoing awake surgery with regular follow-up from diagnosis to death. 50 patients (20/30, female/ male) with gliomas in or very close proximity to language areas or pathways were operated in the time period from November 2005 to June 2011. All patients had no or only mild preoperative language disturbances in the preoperatively performed language testing.

Results: All patients showed initial symptoms with language disturbance (speech arrest, anomia etc) or seizures. In the preoperative language testing 25% of all patients (12 HGG, 0 LGG) had an initial language disturbance. In the immediate postoperative follow-up 89% of all patients had speech production disturbances and semantic disorders, but most of these speech disturbances were transient. One month postoperatively 28% (1/12 LGG/HGG; p = 0.2) of all patients showed mild language disturbances and after 3 months only 13% of all patients (1/5 LGG/HGG, p = 1.0) had mild speech disorders. Gross total tumor resection could be performed in 72% of all patients, in HGG patients in a significant higher number then in LGG patients (30/37 vs. 4/10; p = 0.02). Up to now 10 patients died, and 3 were lost in follow-up. The mean survival time of all patients was 26.8 ± 17.6 months (35 ± 16 LGG, 24.2 ± 17.9 HGG).

Conclusions: Awake craniotomy performing cortical and subcortical language mapping is a safe way for tumor resection in all glioma patients in or close proximity to language areas or pathways. In 13% of all patients mild language disturbances are found 3 months postoperatively, improving continuously. No significant difference in language disturbances could be found comparing LGG to HGG patients. However, this procedure can be offered to glioma patients without or with mild preoperative language disturbances, in order to perform tumor resection and maintain postoperative speech ability, even with a significant higher rate of cross total tumor resection in HGG patients.