title: Awake craniotomy may further improve neurological outcome of intraoperative MRI-guided brain tumor surgery.
abstract: BACKGROUND
  Results of awake craniotomy are compared to results of resections done under general anesthesia in patients operated with IMRI control. We hypothesized that stimulation of the cortex and white matter during awake surgery supplements IMRI control allowing for safer resection of eloquent brain area tumors.
  
  
  METHODS
  The study group consisted of 20 consecutive patients undergoing awake craniotomy with IMRI control. Resection outcome of these patients was compared to a control group of 20 patients operated in the same IMRI suite but under general anesthesia without cortical stimulation. The control group was composed of those patients whose age, sex, tumor location, recurrence and histology best matched to patients in study group.
  
  
  RESULTS
  Cortical stimulation identified functional cortex in eight patients (40 %). Postoperatively the neurological condition in 16 patients (80 %) in the study group was unchanged or improved compared with 13 patients (65 %) in the control group. In both groups, three patients (15 %) had transient impairment symptoms. There was one patient (5 %) with permanent neurological impairment in the study group compared to four patients (20 %) in the control group. These differences between groups were not statistically significant. There was no surgical mortality in either group and the overall infection rate was 5 %. Mean operation time was 4 h 45 min in the study group and 3 h 15 min in the control group.
  
  
  CONCLUSIONS
  The study consisted of a limited patient series, but it implies that awake craniotomy with bipolar cortical stimulation may help to reduce the risk of postoperative impairment following resection of tumors located in or near speech and motor areas also under IMRI control.
authors: Department of Neurosurgery, Oulu University Hospital, University of Oulu, Oulu, Finland, juho.tuominen@ppshp.fi.
authors: Juho
authors: J
authors: Tuominen
authors: Sanna
authors: S
authors: Yrjänä
authors: Anssi
authors: A
authors: Ukkonen
authors: John
authors: J
authors: Koivukangas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000009:adverse effects; D001931:Brain Mapping / Q000379:methods; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D002540:Cerebral Cortex / Q000473:pathology / Q000601:surgery; D003399:Craniotomy / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D009044:Motor Cortex / Q000473:pathology / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014851:Wakefulness / Q000502:physiology*; D055815:Young Adult