title: [Role of the intraoperative electrical brain stimulation in conserving the speech and language function in neurosurgical procedures on conscious patients].
abstract: OBJECTIVE
  To summarize the results gained with awake craniotomies, which were performed in either low grade glioma patients or epilepsy surgical patients whose tumor or epileptogenic zone, was in the vicinity of eloquent, mostly language, cortices. PATIENT SELECTION AND METHODS: In our retrospective study we selected 16 patients who were operated awake between 1999-2011 at the Neurosurgical Department of MAV Kórház Budapest, or at the National Institute of Neurosciences in Budapest, or at the Neurosurgical Department of the University of Debrecen in Debrecen. In the presurgical evaluation if it was possible we performed functional magnetic resonance imaging, tractography and detailed neuropsychological testing. At the National Institute of Neurosciences all patients were operated with the aid of MR guided neuronavigation.
  
  
  RESULTS
  Anesthesia was carried out without complications in all of the 16 cases. Monitoring of sleep deepness has significantly contributed to the safety of anesthesia during the superficial anesthezied states of the operation. The intraoperative neuropsychological tasks used for testing language were sensitive enough to judge the little disturbances in speech during stimulation. Stimulation evoked seizures could be adequately managed during surgery and did not influence the outcome of the procedures. The use of neuronavigation helped significantly by planning the optimal place for the craniotomy and by intraoperative orientation.
  
  
  CONCLUSIONS
  Awake craniotomies require well practiced surgical teams, which requires the cooperation of neuro-anesthesiologits, neurosurgeons, neuropsychologist and electrophysiologists. It has two goals, first to reduce the time of surgery to minimize surgical complications, secondly the detailed intraoperative mapping of cognitive and motor functions to avoid any neurological deficit. The intraoperative anatomical data provided by the neuronavigation and the functional data provided by awake intraoperative stimulation of the patient together serve the safety of the patient which is essential in the neurologically minimal invasive neurosurgical approach of the 21st century.
authors.affiliation: Országos Idegtudományi Intézet, Budapest. l.g.eross@gmail.com
authors.forename: Loránd
authors.initials: L
authors.lastname: Eross
authors.forename: Gábor
authors.initials: G
authors.lastname: Fekete
authors.forename: László
authors.initials: L
authors.lastname: Entz
authors.forename: Dániel
authors.initials: D
authors.lastname: Fabó
authors.forename: Csaba
authors.initials: C
authors.lastname: Borbély
authors.forename: Lajos Rudolf
authors.initials: LR
authors.lastname: Kozák
authors.forename: Mónika
authors.initials: M
authors.lastname: Andrejkovics
authors.forename: Sándor
authors.initials: S
authors.lastname: Czirják
authors.forename: Imre
authors.initials: I
authors.lastname: Fedorcsák
authors.forename: László
authors.initials: L
authors.lastname: Novák
authors.forename: László
authors.initials: L
authors.lastname: Bognár
mesh_terms: D000328:Adult; D000368:Aged; D001931:Brain Mapping / Q000379:methods*; D003071:Cognition; D016292:Procedural Sedation; D003399:Craniotomy / Q000379:methods*; D004558:Electric Stimulation; D005260:Female; D006801:Humans; D007807:Language Tests; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation; D011597:Psychomotor Performance; D012189:Retrospective Studies; D012640:Seizures; D012890:Sleep; D013060:Speech; D014851:Wakefulness