Awake Resection of Adult Supratentorial Low-grade Gliomas Located within or Adjacent to Eloquent Areas

Czech version

Authors: A. Šteňo ¹; V. Šteňová ²; V. Belan ³; V. Hollý ⁴; J. Šurkala ¹; J. Šteňo ¹
Authors‘ workplace: UN Bratislava Neurochirurgická klinika LF UK ¹; UN Bratislava Ambulancia klinickej logopédie ²; UN Bratislava Rádiodiagnostická klinika SZU ³; UN Bratislava Klinika anestéziológie a intenzívnej medicíny SZU ⁴
Published in: Cesk Slov Neurol N 2011; 74/107(5): 539-549
Category: Original Paper

Overview

Aim:
The aim of this work was to present the advantages and limits of the use of awake resection (AR) in the surgical treatment of supratentorial low-grade gliomas (LGG) located within or adjacent to eloquent areas; to evaluate the radicality of resections and functional outcome; and to document observations of certain brain structure functions. Patients and methods: The prospectively-studied series included 20 adult patients operated upon in a period of 41 months. All the tumours were located within or adjacent to speech and language, or motor eloquent, structures. Speech and language functions were intra-operatively assessed by a speech and language therapist. Calculation of tumour residua volumes was based on a postoperative fluid attenuated inversion recovery (FLAIR) magnetic resonance sequence. Results: Gross total removal was achieved in one patient, subtotal removal (residue smaller than 10 cm3) in 12, and partial removal in seven patients. Two temporary deficits and one minor permanent neurological deficit were observed. The use of direct electrical stimulation enabled anatomical localization and function of the following cortical and subcortical structures to be identified and observed: primary and supplementary motor area, motor pathways, Broca’s and Wernicke’s areas, fasciculus arcuatus, fasciculus subcallosus and corpus callosum. Conclusions: AR is a worthwhile contribution to the surgical treatment of supratentorial LGG. In addition to avoidance of surgical sequelae, AR allows an extensive, safe resection that may not be safely achievable with general anaesthesia even with the use of current diagnostic imaging methods and electrophysiological neuromonitoring, particularly in cases involving LGG located within or adjacent to speech and language areas. The incidence of new and permanent deficits is low. However, resection in certain areas remains problematical, even with the use of AR. Some complex neurological disorders of function may not be readily assessed intra-operatively, despite surgery in a patient who is awake. The methodology of intra-operative brain function testing should improve over time.

Key words:
low-grade glioma – awake resection – eloquent area – direct electrical stimulation

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