The strategies of glioma surgery in cerebral eloquent areas

Objective To study the surgical skills of awake surgery of gliomas harboring in eloquent areas. Methods 13 cases of gliomas in eloquent areas were underwent awake surgery procedures assisted with neuro-navigation and brain functional mapping by soma- tosensory evoked potential(SEP) and cortical electrical stimulation. Results All cases received safety awake surgery for accurate location of both lesions and eloquent areas and maximal resection of tumors. The central sulci were located by SEP in 6 cases. 9 cases of motor cortices and 4 cases of motor speech centers were confirmed by direct cortical stimulation. The lesions were totally removed in 11 patients, and subtotal removed in the other 2 patients. There is no deterioration of neurological functional after operation. The preoperative neurological deficits were improved in all patients, and completely disappeared in 10 patients. Only one patient who suffered frequently seizure got an epileptic attack during the awaking period in the operation. And another patient was suffered from brain swelling during the awaking procedure. There were no other complications during or after the operations. All patients had no painful experience due to operations. Conclusions It is a reliable, precise and safe method that intraoperative mapping of eloquent areas by somatosensory evoked potential and cortical electrical stimulation under awaking anaesthesia, which allow a maximum resection of gliomas and protection of brain function.