P16.07 Individual task specific testing associated with intra-operative MRI during awake craniotomy surgery for low grade gliomas to improve extent of resection and minimize morbidity

Abstract

Brain low grade lesions of glial origin (LGG) especially those located in or near eloquent areas pose a challenging task for neurosurgeons operating such tumors. Even after the new classification of LGG, age, IDH status and extent of resection (EOR) seem to represent the main points that stratify patients in low or high risk. Often, surgery is the first step in the treatment and may positively impact the overall survival if extensive resection can be achieved with lowest morbidity. Therefore, neurophysiologic monitoring and intra operative MRI can be considered valuable tools in aiding maximal safe resection. Awake surgery has an important role when left side low frontal or posterior temporoparietal gliomas are to be operated on and individualized testing may influence, to our knowledge, on the extent and quality of resection, since anatomic variability may be encountered on different individuals during awake mapping. MATERIALS AND METHODS: a total of 16 LGG (10 astrocytomas, 4 oligoastrocytomas and 2 oligodendroglioma) were submitted to surgery, using awake craniotomy, neurophysiologic monitoring and intra operative MRI. Depending on each patient personal background, when appropriate and with personal consent prior to surgery, individualized testing based on mainly labor activities and hobbies such as playing the guitar and singing, praying, and oral math calculations were conducted and evaluated by a neurophysiologist, in conjunction with brain intra operative cortical and subcortical mapping. 9 patients were male and 7 were female. Median age was 38, maximal age was 54 and the minimal age was 28. All patients had lesions located in or near eloquent speech and/or motor areas. All patients were submitted to immediate post operative CT scan prior to UCI care and all were submitted to control MRI scan to estimate the EOR. 70% patients presented with headache, 62, 5% with seizure, only 1 patient presented as an incidental finding. Post operatively, 10 patients were neurologically intact, 5 had transient worsening of the previous neurological deficit and only one did not totally recover after 3 months post operation. The use of iMRI was helpful to improve EOR in 37,5% cases and positive mapping using individual speech testing that limited resection occurred in 56,25% cases. Gross total resection was achieved in 10 patients. CONCLUSION: brain mapping is an essential tool when performing awake surgery and may be even more specific when combined to individualized intra operative testing. Intra operative MRI, in our cases, combined to neuromonitoring, was a valuable tool when seeking maximal safe LGG resection. BACKGROUND: Brain tumors involving the primary motor cortex are often deemed unresectable due to the potential neurological consequences that result from injury to this region. Nevertheless, we have challenged this dogma for many years, and used asleep, as well as awake, intraoperative stimulation mapping to maximize extent of resection. It remains unclear whether these tumors can be resected with acceptable mor...

The feasibility and added value of mapping music during awake craniotomy: A systematic review

“…We excluded 642 studies after title and abstract screening, resulting in 18 studies to be assessed for full‐text. We excluded nine studies after full‐text screening: six studies due to a lack of intra‐operative music performance (Gasenzer et al, 2017b; Gayoso García et al, 2015; Riva et al, 2016; Roux et al, 2007; Schulz et al, 2005; Suarez et al, 2010), one conference abstract (Gripp et al, 2017), one case sang unexpectedly after stimulation but not for mapping purposes (Herbet et al, 2015) and one case (Breshears et al, 2019) due to overlap with another included study (Leonard et al, 2019). Cross‐referencing led to one additional study (Zhang et al, 2013) resulting in 10 studies (n s ) and 14 patients (n c ) included for the final analysis.…”