Contemporary techniques during surgery of gliomas in eloquent areas

Objective To study the new techniques and methods during surgery of brain gliomas located in supratentorial eloquent areas. Methods 48 patients with supratentorial gliomas were evaluated with routine MRI and DTI and fMRI to map the eloquent cerebral cortex and white matter fiber. The patients were operated under awake anesthesia with neuro-navigation and ultrasonic wave B for locating the tumor and intra-operative direct electrical stimulation for functional mapping of the eloquent areas. The maximal resection of tumors and minimal damage of the eloquent areas were the surgical goal for all patients. The follow-up periods were 3 to 42 months. Results 16 patients were detected the central sulcus by cortical somatosensory evoked potential. 42 patients were detected the motor areas by intra-operative direct electrical stimulation and 16 patients for language related cortex. Total resection was performed in 35 cases, subtotal resection in 9 cases and partial resection in 4 cases. 44 patients got the better neurological results after surgery, however, 36 patients had the temporary neurological deficits. Four patients had permanent neurological deficits. No patients died and complained of pain during the operation. Conclusion Awake anesthesia, intra-operative direct electrical stimulations and intra-operative ultrasonic wave B are three basic techniques for surgery of brain gliomas located in supratentorial eloquent areas. Pre-operative DTI and fMRI and intra-operative neuro-navigation will provide very useful help for the surgery. Combined using these techniques can ascertain the relationship of eloquent areas and the extent of gliomas, and allows a minimization of post-operative neurological deficit and maximum resection of tumors.