Modern surgical strategy for gliomas in eloquent areas

Objective To study the new techniques and methods during surgery of brain gliomas located in supratentorial eloquent areas.Methods 112 patients with supratentorial gliomas were operated under awake anesthesia with ultrasonography for locating the tumor and intra-operative direct electrical stimulation(DES)for functional mapping of the eloquent areas. The maximal resection of tumors and minimal damage of the eloquent areas were the surgical goal of all patients.All patients were followed up from 3 to 84 months.Results Of 112 patients,107 were achieved awake and alert during brain mapping and resection of the lesions,99 were detected the motor areas by intra-operative direct electrical stimulation and 61 for language related cortex and 18 for sensory cortex.Of 112 patients,66 received totally resection of lesions,34 subtotal and 12 partial.37 patients had transitory post-operative paralysis,26 with transitory post-operative aphasia and 3 with permanent neurological sequelae.No patient died of surgery or complaint of pain recollection following operation.Conclusions Awake anesthesia,intra-operative DES and sonography are three core techniques for the resection of intrinsic cerebral tumors near the eloquent areas.This new concept allows an improvement in the quality of surgical resection of lesions on eloquent areas.