gms | German Medical Science

Objective: Awake glioma surgery is used for resection of brain tumors adjacent to eloquent brain areas (speech or motor cortex). The aim of surgery is to maximize the extent of resection and minimize postoperative neurological deficits. Therefore, intraoperative high-field MRI combined with neuronavigation was used for resection control in patients who underwent awake surgery.

Methods: From December 2005 to November 2011 82 operations in 77 patients (45 male and 32 female, age 15–77 years; mean 45 years) with glial tumors (1 GradeI, 11 grade II, 27 Grade III, 43 Grade IV) adjacent to eloquent brain areas were performed under local anaesthesia. Data were analysed from a prospektive database. Tumor volume, histology, ectent of tumor resection, OR-time, MR-scan-duration, neurological performance, age, gender and outcome were evaluated. Intraoperative MRI (1,5 Tesla) and constant neurological and neuropsychological monitoring were performed assisted by neuronavigation and 5-ALA-flourescence. Prior to and after operation, the patints were tested neuropsychologically.

Results: Mean tumor volume was 33.3 cm³. Mean follow-up was 21 months (1–72 months). Mean operation time was 260 minutes (80–730 minutes, mean MRI-scan-duration was 28 minutes (9–74 minutes). All images yielded diagnostic quality. In 61 operations all MR-morphologically detectable tumor tissue was resected. In 52 cases the patients had no permanent neurological deficit, 4 improved, 17 had a light and 6 a moderate deficit. 3 patients showed a severe deterioration. There was no perioperative mortality.

Conclusions: Awake surgery combined with intraoperative MRI-control and neuronavigation is a safe approach to maximize the extent of tumor removal and to minimize the resultant neurological deficits in the treatment of gliomas involving eloquent cortex areas.