Cortical stimulation of language fields under local anesthesia: optimizing removal of brain lesions adjacent to speech areas.
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.
Amorim
Robson Luis Oliveira de
RL
Division of Functional Neurosurgery, Department of Neurology, Clinics Hospital, University of São Paulo School of Medicine, São Paulo, Brazil. amorim.robson@uol.com.br
Almeida
Antônio Nogueira de
AN
Aguiar
Paulo Henrique Pires de
PH
Fonoff
Erich Talamoni
ET
Itshak
Suely
S
Fuentes
Daniel
D
Teixeira
Manoel Jacobsen
MJ
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
D000779:Anesthetics, Local