Awake glioma surgery: technical evolution and nuances

Introduction Multiple studies have demonstrated that improved extent of resection is associated with longer overall survival for patients with both high and low grade glioma. Awake craniotomy was developed as a technique for maximizing resection whilst preserving neurological function. Methods We pe...

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Bibliographic Details
Published in:Journal of neuro-oncology 2020-05, Vol.147 (3), p.515-524
Main Authors: Gogos, Andrew J., Young, Jacob S., Morshed, Ramin A., Hervey-Jumper, Shawn L., Berger, Mitchel S.
Format: Article
Language:English
Subjects:
Brain mapping
Brain Neoplasms - surgery
Craniotomy - methods
Electric Stimulation
Glioma
Glioma - surgery
Humans
Literature reviews
Medicine
Medicine & Public Health
Monitoring, Intraoperative - methods
Neurology
Oncology
Surgery
Topic Review
Treatment Outcome
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Summary:Introduction Multiple studies have demonstrated that improved extent of resection is associated with longer overall survival for patients with both high and low grade glioma. Awake craniotomy was developed as a technique for maximizing resection whilst preserving neurological function. Methods We performed a comprehensive review of the literature describing the history, indications, techniques and outcomes of awake craniotomy for patients with glioma. Results The technique of awake craniotomy evolved to become an essential tool for resection of glioma. Many perceived contraindications can now be managed. We describe in detail our preferred technique, the testing paradigms utilized, and critically review the literature regarding functional and oncological outcome. Conclusions Awake craniotomy with mapping has become the gold standard for safely maximizing extent of resection for tumor in or near eloquent brain. Cortical and subcortical mapping methods have been refined and the technique is associated with an extremely low rate of complications.
ISSN:0167-594X
1573-7373
DOI:10.1007/s11060-020-03482-z