title: Awake craniotomy for gliomas in a high-field intraoperative magnetic resonance imaging suite: analysis of 42 cases.
abstract: OBJECTIVE
  The object of this study was to describe the experience of combining awake craniotomy techniques with high-field (1.5 T) intraoperative MRI (iMRI) for tumors adjacent to eloquent cortex.
  
  
  METHODS
  From a prospective database the authors obtained and evaluated the records of all patients who had undergone awake craniotomy procedures with cortical and subcortical mapping in the iMRI suite. The integration of these two modalities was assessed with respect to safety, operative times, workflow, extent of resection (EOR), and neurological outcome.
  
  
  RESULTS
  Between February 2010 and December 2011, 42 awake craniotomy procedures using iMRI were performed in 41 patients for the removal of intraaxial tumors. There were 31 left-sided and 11 right-sided tumors. In half of the cases (21 [50%] of 42), the patient was kept awake for both motor and speech mapping. The mean duration of surgery overall was 7.3 hours (range 4.0-13.9 hours). The median EOR overall was 90%, and gross-total resection (EOR ≥ 95%) was achieved in 17 cases (40.5%). After viewing the first MR images after initial resection, further resection was performed in 17 cases (40.5%); the mean EOR in these cases increased from 56% to 67% after further resection. No deficits were observed preoperatively in 33 cases (78.5%), and worsening neurological deficits were noted immediately after surgery in 11 cases (26.2%). At 1 month after surgery, however, worsened neurological function was observed in only 1 case (2.3%).
  
  
  CONCLUSIONS
  There was a learning curve with regard to patient positioning and setup times, although it did not adversely affect patient outcomes. Awake craniotomy can be safely performed in a high-field (1.5 T) iMRI suite to maximize tumor resection in eloquent brain areas with an acceptable morbidity profile at 1 month.
authors.affiliation: Departments of Neurosurgery.
authors.forename: Marcos V C
authors.initials: MV
authors.lastname: Maldaun
authors.forename: Shumaila N
authors.initials: SN
authors.lastname: Khawja
authors.forename: Nicholas B
authors.initials: NB
authors.lastname: Levine
authors.forename: Ganesh
authors.initials: G
authors.lastname: Rao
authors.forename: Frederick F
authors.initials: FF
authors.lastname: Lang
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Weinberg
authors.forename: Sudhakar
authors.initials: S
authors.lastname: Tummala
authors.forename: Charles E
authors.initials: CE
authors.lastname: Cowles
authors.forename: David
authors.initials: D
authors.lastname: Ferson
authors.forename: Anh-Thuy
authors.initials: AT
authors.lastname: Nguyen
authors.forename: Raymond
authors.initials: R
authors.lastname: Sawaya
authors.forename: Dima
authors.initials: D
authors.lastname: Suki
authors.forename: Sujit S
authors.initials: SS
authors.lastname: Prabhu
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D005260:Female; D005910:Glioma / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011446:Prospective Studies; D014851:Wakefulness; D055815:Young Adult
keywords: DTI = diffusion tensor imaging; DWI = diffusion-weighted imaging; EOR; EOR = extent of resection; GTR = gross-total resection; LMA = laryngeal mask airway; OR = operating room; PR = partial resection; STR = subtotal resection; awake craniotomy; cortical mapping; fMRI = functional MRI; glioma surgery; iMRI; iMRI = intraoperative MRI; oncology