title: Cortical stimulation of language fields under local anesthesia: optimizing removal of brain lesions adjacent to speech areas.
abstract: OBJECTIVE
  The main objective when resecting benign brain lesions is to minimize risk of postoperative neurological deficits. We have assessed the safety and effectiveness of craniotomy under local anesthesia and monitored conscious sedation for the resection of lesions involving eloquent language cortex.
  
  
  METHODS
  A retrospective review was performed on a consecutive series of 12 patients who underwent craniotomy under local anesthesia between 2001 and 2004. All patients had lesions close to the speech cortex. All resection was verified by post-operative imaging. Six subjects were male and 6 female, and were aged between 14 and 52 years.
  
  
  RESULTS
  Lesions comprised 7 tumour lesions, 3 cavernomas and 1 dermoid cyst. Radiological gross total resection was achieved in 66% of patients while remaining cases had greater than 80% resection. Only one patient had a post-operative permanent deficit, whilst another had a transient post-operative deficit. All patients with uncontrollable epilepsy had good outcomes after surgery. None of our cases subsequently needed to be put under general anesthesia.
  
  
  CONCLUSIONS
  Awake craniotomy with brain mapping is a safe technique and the "gold standard" for resection of lesions involving language areas.
authors.affiliation: Division of Functional Neurosurgery, Department of Neurology, Clinics Hospital, University of São Paulo School of Medicine, São Paulo, Brazil. amorim.robson@uol.com.br
authors.forename: Robson Luis Oliveira de
authors.initials: RL
authors.lastname: Amorim
authors.forename: Antônio Nogueira de
authors.initials: AN
authors.lastname: Almeida
authors.forename: Paulo Henrique Pires de
authors.initials: PH
authors.lastname: Aguiar
authors.forename: Erich Talamoni
authors.initials: ET
authors.lastname: Fonoff
authors.forename: Suely
authors.initials: S
authors.lastname: Itshak
authors.forename: Daniel
authors.initials: D
authors.lastname: Fuentes
authors.forename: Manoel Jacobsen
authors.initials: MJ
authors.lastname: Teixeira
mesh_terms: D000293:Adolescent; D000328:Adult; D000772:Anesthesia, Local; D000779:Anesthetics, Local / Q000008:administration & dosage; D001931:Brain Mapping / Q000379:methods*; D001932:Brain Neoplasms / Q000601:surgery*; D002540:Cerebral Cortex / Q000033:anatomy & histology / Q000502:physiology / Q000601:surgery*; D016292:Procedural Sedation / Q000379:methods*; D003399:Craniotomy / Q000379:methods*; D004558:Electric Stimulation; D005260:Female; D006801:Humans; D007806:Language Disorders / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D019635:Neurosurgical Procedures / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D013060:Speech / Q000502:physiology; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local