title: Early Experience with Combining Awake Craniotomy and Intraoperative Navigable Ultrasound for Resection of Eloquent Region Gliomas.
abstract: IntroductionOptimal resection of tumors in eloquent locations requires a combination of intraoperative imaging and functional monitoring during surgery. Combining awake surgery with intraoperative magnetic resonanceis logistically challenging. Navigable ultrasound (US) is a useful alternative in such cases.MethodsA total of 22 subjects with eloquent tumors were operated on (1 intended biopsy and 21 intended radical resections) using combined modality three-dimensional (3D) US and awake craniotomy with intraoperative clinical monitoring. We describe the technical details for these cases specifically addressing the feasibility of combining the two modalities.ResultsUS was used for resection control in 18 cases. There were technical limitations in three cases. Transient intraoperative worsening was encountered in eight, necessitating premature termination of the procedure. All patients tolerated the awake procedure well. Mean duration of the surgery was 3.2 hours. Radical resections were obtained in 14 of 18 where this was intended and in 12 of the 13 where there was no adverse intraoperative monitoring event prompting premature termination of the resection.ConclusionsCombining awake surgery with 3DUS is feasible and beneficial. It does not entail any additional surgical workflow modification or patient discomfort. This combined modality intraoperative monitoring can be beneficial for eloquent region tumors.
authors.affiliation: Department of Neurosurgery, Tata Memorial Centre, Mumbai, India.
authors.forename: Aliasgar
authors.initials: A
authors.lastname: Moiyadi
authors.affiliation: Department of Neurosurgery, Tata Memorial Centre, Mumbai, India.
authors.forename: Prakash
authors.initials: P
authors.lastname: Shetty
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D038361:Neuronavigation / Q000379:methods*; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult