Awake mapping for resection of cavernous angioma and surrounding gliosis in the left dominant hemisphere: surgical technique and functional results

Abstract

These results suggest that intraoperative cortical-subcortical stimulation in awake patients represents a valuable adjunct to image-guided surgery with the aim of selecting the safer surgical approach for CAs involving eloquent areas. Moreover, such online mapping can be helpful when removing the pericavernomatous gliosis while preserving functional structures, which can persist within the hemosiderin rim. Thus, the authors propose that awake surgery be routinely considered, both to optimize the resection and to improve the quality of life through seizure control and avoidance of (re)bleeding for CAs located in the left dominant hemisphere.

Low Rate of Intraoperative Seizures During Awake Craniotomy in a Prospective Cohort with 374 Supratentorial Brain Lesions: Electrocorticography Is Not Mandatory

“…Awake craniotomy (AC) associated with intraoperative electrical cortical and subcortical mapping represents a reliable method to optimize the benefit-risk ratio of surgery for intraaxial supratentorial brain lesions, including gliomas, metastasis and cavernomas (11,19,21). Indeed, a large amount of recent series has shown that this technique enabled surgical removal of tumors in highly functional regions previously considered as inoperable (10,20), with nonetheless a preservation (or even an improvement) of quality of life thanks to mechanisms of neuroplasticity (especially in slow-growing lesions as low-grade gliomas [12]), and with an increase of the extent of resection (2,3,6,9,28,29).…”

Passive fMRI mapping of language function for pediatric epilepsy surgical planning: Validation using Wada, ECS, and FMAER

“…Resection surgery can raise the risk of damaging one or both language centers of the brain, resulting in permanent postsurgical language deficit (Duffau et al 2009; Loiselle et al 2012; Matsuda et al 2012). Determining the lateralization and localization of the essential language centers in relation to the surgical site therefore provides surgeons with a valuable tool for evaluating risk of postoperative morbidity associated with language deficit (Abou-Khalil et al 2007; Sharan et al 2010).…”

Technical, Anatomical, and Functional Study after Removal of a Symptomatic Cavernous Angioma Located in Deep Wernicke’s Territories with Cortico-Subcortical Awake Mapping

“…The prevalence of central nervous system (CNS) cavernous angiomas (CAs) ranges between 0.02 and 0.5% in the population, and they account for the 5–10% of all cerebro-vascular malformations (CVMs) [1–3]. These lesions usually present between the 3rd and 5th decades of life [4], the patients experience seizures in 50–70% of cases [5–8], and the natural history of CAs is characterized by growth and/or micro or macrobleeding [5, 9–12].…”

“…Firstly, CAs' resection is frequently not sufficient to obtain the best postoperative seizures control. Even if still debated, in fact, the removal of perilesional hemosiderin gliotic rim seems crucial to reach the best control of seizures [3, 15–20], and the common mini-invasive approach is not always sufficient for the best outcome. Secondly, if subcortical CA is located in regions with high eloquent fiber pathways crossing, eventual lesion of white matter bundles will produce permanent deficits, because plasticity has not been demonstrated for human white matter.…”