Awake craniotomy of gliomas in eloquent areas: an analysis of 19 cases

Objective To discuss the techniques and methods of surgery for brain gliomas located in eloquent areas at awake anesthesia. Methods Nineteen patients with brain gliomas in eloquent areas, admitted to our hospital from December 2014 to May 2017, were operated under awake anesthesia with neuronavigation and intraoperative ultrasonography for locating the lesions and intraoperative direct electrical stimulation for functional mapping of the eloquent areas. All patients were followed up from 3 to 18 months; the surgical efficacies were analyzed. Results Of 19 patients, 18 (94.74%) were achieved awake and alert during brain mapping and resection of the tumors; 17 (89.47%) were detected the motor areas by intraoperative direct electrical stimulation, 6 (31.58%) were detected the sensory cortex and 12 (63.16%) were detected language related cortex. Of 19 patients, MR imaging 2-3 months after surgery indicated that 5 (26.32%) received total resection of lesions, 9 (47.37%) subtotal resection of lesions and 5 (26.32%) partial resection of lesions. Seven patients (36.84%) had transitory postoperative aphasia, 4 (21.05%) were with transitory postoperative dyskinesia and one (5.26%) with permanent dyskinesia. Conclusion Comprehensive applications of awake anesthesia, neuronavigation, intraoperative ultrasonography and intraoperative direct electrical stimulation technologies allow maximum safe resection of gliomas in eloquent areas and protection of brain function. Key words: Glioma; Awake anesthesia; Electrical stimulation; Neuronavigation; Intraoperative ultrasonography