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Awake Mapping Optimizes the Extent of Resection for LowGrade Gliomas in Eloquent Areas

De Benedictis, Alessandro MD; Moritz-Gasser, Sylvie ST; Duffau, Hugues MD, PhD

doi: 10.1227/01.NEU.0000369514.74284.78
Clinical Studies

BACKGROUND: Awake craniotomy with intraoperative electrical mapping is a reliable method to minimize the risk of permanent deficit during surgery for low-grade glioma located within eloquent areas classically considered inoperable. However, it could be argued that preservation of functional sites might lead to a lesser degree of tumor removal. To the best of our knowledge, the extent of resection has never been directly compared between traditional and awake procedures.

OBJECTIVE: We report for the first time a series of patients who underwent 2 consecutive surgeries without and with awake mapping.

METHODS: Nine patients underwent surgery for a low-grade glioma in functional sites under general anesthesia in other institutions. The resection was subtotal in 3 cases and partial in 6 cases. There was a postoperative worsening in 3 cases. We performed a second surgery in the awake condition with intraoperative electrostimulation. The resection was performed according to functional boundaries at both the cortical and subcortical levels.

RESULTS: Postoperative magnetic resonance imaging showed that the resection was complete in 5 cases and subtotal in 4 cases (no partial removal) and that it was improved in all cases compared with the first surgery (P = .04). There was no permanent neurological worsening. Three patients improved compared with the presurgical status. All patients returned to normal professional and social lives.

CONCLUSION: Our results demonstrate that awake surgery, known to preserve the quality of life in patients with low-grade glioma, is also able to significantly improve the extent of resection for lesions located in functional regions.

Department of Surgical Sciences, Neurosurgical Unit, University of Insubria, Varese, Italy (Benedictis)

Department of Neurosurgery, Hôpital Gui de Chauliac, CHU Montpellier, Montpellier, France (Moritz-Gasser)

Department of Neurosurgery, Hôpital Gui de Chauliac, and Institut of Neuroscience of Montpellier, INSERM U583, Plasticity of Central Nervous System, Human Stem Cells and Glial Tumors, Hôpital Saint Eloi, CHU Montpellier, Montpellier, France (Duffau)

Reprint requests: Hugues Duffau, MD, PhD, Department of Neurosurgery, Hôpital Gui de Chauliac, CHU Montpellier, 80 Av Augustin Fliche, 34295 Montpellier, France. E-mail:

Received, March 4, 2009.

Accepted, November 30, 2009.

Copyright © by the Congress of Neurological Surgeons