Awake craniotomy and electrophysiological mapping for eloquent area tumours

Ari George Chacko, Santhosh George Thomas, K. Srinivasa Babu, Roy Thomas Daniel, Geeta Chacko, Krishna Prabhu, Verghese Cherian, Grace Korula

Research output: Contribution to journalArticle

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Abstract

Objective: An awake craniotomy facilitates radical excision of eloquent area gliomas and ensures neural integrity during the excision. The study describes our experience with 67 consecutive awake craniotomies for the excision of such tumours. Methods: Sixty-seven patients with gliomas in or adjacent to eloquent areas were included in this study. The patient was awake during the procedure and intraoperative cortical and white matter stimulation was performed to safely maximize the extent of surgical resection. Results: Of the 883 patients who underwent craniotomies for supratentorial intraaxial tumours during the study period, 84 were chosen for an awake craniotomy. Sixty-seven with a histological diagnosis of glioma were included in this study. There were 55 men and 12 women with a median age of 34.6 years. Forty-two (62.6%) patients had positive localization on cortical stimulation. In 6 (8.9%) patients white matter stimulation was positive, five of whom had responses at the end of a radical excision. In 3 patients who developed a neurological deficit during tumour removal, white matter stimulation was negative and cessation of the surgery did not result in neurological improvement. Sixteen patients (24.6%) had intraoperative neurological deficits at the time of wound closure, 9 (13.4%) of whom had persistent mild neurological deficits at discharge, while the remaining 7 improved to normal. At a mean follow-up of 40.8 months, only 4 (5.9%) of these 9 patients had persistent neurological deficits. Conclusion: Awake craniotomy for excision of eloquent area gliomas enable accurate mapping of motor and language areas as well as continuous neurological monitoring during tumour removal. Furthermore, positive responses on white matter stimulation indicate close proximity of eloquent cortex and projection fibres. This should alert the surgeon to the possibility of postoperative deficits to change the surgical strategy. Thus the surgeon can resect tumour safely, with the knowledge that he has not damaged neurological function up to that point in time thus maximizing the tumour resection and minimizing neurological deficits.

Original languageEnglish (US)
Pages (from-to)329-334
Number of pages6
JournalClinical Neurology and Neurosurgery
Volume115
Issue number3
DOIs
StatePublished - Mar 1 2013

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Craniotomy
Glioma
Neoplasms
Supratentorial Neoplasms
Motor Cortex
Language
White Matter
Wounds and Injuries

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Chacko, A. G., Thomas, S. G., Babu, K. S., Daniel, R. T., Chacko, G., Prabhu, K., ... Korula, G. (2013). Awake craniotomy and electrophysiological mapping for eloquent area tumours. Clinical Neurology and Neurosurgery, 115(3), 329-334. https://doi.org/10.1016/j.clineuro.2012.10.022
Chacko, Ari George ; Thomas, Santhosh George ; Babu, K. Srinivasa ; Daniel, Roy Thomas ; Chacko, Geeta ; Prabhu, Krishna ; Cherian, Verghese ; Korula, Grace. / Awake craniotomy and electrophysiological mapping for eloquent area tumours. In: Clinical Neurology and Neurosurgery. 2013 ; Vol. 115, No. 3. pp. 329-334.
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abstract = "Objective: An awake craniotomy facilitates radical excision of eloquent area gliomas and ensures neural integrity during the excision. The study describes our experience with 67 consecutive awake craniotomies for the excision of such tumours. Methods: Sixty-seven patients with gliomas in or adjacent to eloquent areas were included in this study. The patient was awake during the procedure and intraoperative cortical and white matter stimulation was performed to safely maximize the extent of surgical resection. Results: Of the 883 patients who underwent craniotomies for supratentorial intraaxial tumours during the study period, 84 were chosen for an awake craniotomy. Sixty-seven with a histological diagnosis of glioma were included in this study. There were 55 men and 12 women with a median age of 34.6 years. Forty-two (62.6{\%}) patients had positive localization on cortical stimulation. In 6 (8.9{\%}) patients white matter stimulation was positive, five of whom had responses at the end of a radical excision. In 3 patients who developed a neurological deficit during tumour removal, white matter stimulation was negative and cessation of the surgery did not result in neurological improvement. Sixteen patients (24.6{\%}) had intraoperative neurological deficits at the time of wound closure, 9 (13.4{\%}) of whom had persistent mild neurological deficits at discharge, while the remaining 7 improved to normal. At a mean follow-up of 40.8 months, only 4 (5.9{\%}) of these 9 patients had persistent neurological deficits. Conclusion: Awake craniotomy for excision of eloquent area gliomas enable accurate mapping of motor and language areas as well as continuous neurological monitoring during tumour removal. Furthermore, positive responses on white matter stimulation indicate close proximity of eloquent cortex and projection fibres. This should alert the surgeon to the possibility of postoperative deficits to change the surgical strategy. Thus the surgeon can resect tumour safely, with the knowledge that he has not damaged neurological function up to that point in time thus maximizing the tumour resection and minimizing neurological deficits.",
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Chacko, AG, Thomas, SG, Babu, KS, Daniel, RT, Chacko, G, Prabhu, K, Cherian, V & Korula, G 2013, 'Awake craniotomy and electrophysiological mapping for eloquent area tumours', Clinical Neurology and Neurosurgery, vol. 115, no. 3, pp. 329-334. https://doi.org/10.1016/j.clineuro.2012.10.022

Awake craniotomy and electrophysiological mapping for eloquent area tumours. / Chacko, Ari George; Thomas, Santhosh George; Babu, K. Srinivasa; Daniel, Roy Thomas; Chacko, Geeta; Prabhu, Krishna; Cherian, Verghese; Korula, Grace.

In: Clinical Neurology and Neurosurgery, Vol. 115, No. 3, 01.03.2013, p. 329-334.

Research output: Contribution to journalArticle

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T1 - Awake craniotomy and electrophysiological mapping for eloquent area tumours

AU - Chacko, Ari George

AU - Thomas, Santhosh George

AU - Babu, K. Srinivasa

AU - Daniel, Roy Thomas

AU - Chacko, Geeta

AU - Prabhu, Krishna

AU - Cherian, Verghese

AU - Korula, Grace

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N2 - Objective: An awake craniotomy facilitates radical excision of eloquent area gliomas and ensures neural integrity during the excision. The study describes our experience with 67 consecutive awake craniotomies for the excision of such tumours. Methods: Sixty-seven patients with gliomas in or adjacent to eloquent areas were included in this study. The patient was awake during the procedure and intraoperative cortical and white matter stimulation was performed to safely maximize the extent of surgical resection. Results: Of the 883 patients who underwent craniotomies for supratentorial intraaxial tumours during the study period, 84 were chosen for an awake craniotomy. Sixty-seven with a histological diagnosis of glioma were included in this study. There were 55 men and 12 women with a median age of 34.6 years. Forty-two (62.6%) patients had positive localization on cortical stimulation. In 6 (8.9%) patients white matter stimulation was positive, five of whom had responses at the end of a radical excision. In 3 patients who developed a neurological deficit during tumour removal, white matter stimulation was negative and cessation of the surgery did not result in neurological improvement. Sixteen patients (24.6%) had intraoperative neurological deficits at the time of wound closure, 9 (13.4%) of whom had persistent mild neurological deficits at discharge, while the remaining 7 improved to normal. At a mean follow-up of 40.8 months, only 4 (5.9%) of these 9 patients had persistent neurological deficits. Conclusion: Awake craniotomy for excision of eloquent area gliomas enable accurate mapping of motor and language areas as well as continuous neurological monitoring during tumour removal. Furthermore, positive responses on white matter stimulation indicate close proximity of eloquent cortex and projection fibres. This should alert the surgeon to the possibility of postoperative deficits to change the surgical strategy. Thus the surgeon can resect tumour safely, with the knowledge that he has not damaged neurological function up to that point in time thus maximizing the tumour resection and minimizing neurological deficits.

AB - Objective: An awake craniotomy facilitates radical excision of eloquent area gliomas and ensures neural integrity during the excision. The study describes our experience with 67 consecutive awake craniotomies for the excision of such tumours. Methods: Sixty-seven patients with gliomas in or adjacent to eloquent areas were included in this study. The patient was awake during the procedure and intraoperative cortical and white matter stimulation was performed to safely maximize the extent of surgical resection. Results: Of the 883 patients who underwent craniotomies for supratentorial intraaxial tumours during the study period, 84 were chosen for an awake craniotomy. Sixty-seven with a histological diagnosis of glioma were included in this study. There were 55 men and 12 women with a median age of 34.6 years. Forty-two (62.6%) patients had positive localization on cortical stimulation. In 6 (8.9%) patients white matter stimulation was positive, five of whom had responses at the end of a radical excision. In 3 patients who developed a neurological deficit during tumour removal, white matter stimulation was negative and cessation of the surgery did not result in neurological improvement. Sixteen patients (24.6%) had intraoperative neurological deficits at the time of wound closure, 9 (13.4%) of whom had persistent mild neurological deficits at discharge, while the remaining 7 improved to normal. At a mean follow-up of 40.8 months, only 4 (5.9%) of these 9 patients had persistent neurological deficits. Conclusion: Awake craniotomy for excision of eloquent area gliomas enable accurate mapping of motor and language areas as well as continuous neurological monitoring during tumour removal. Furthermore, positive responses on white matter stimulation indicate close proximity of eloquent cortex and projection fibres. This should alert the surgeon to the possibility of postoperative deficits to change the surgical strategy. Thus the surgeon can resect tumour safely, with the knowledge that he has not damaged neurological function up to that point in time thus maximizing the tumour resection and minimizing neurological deficits.

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