title: Surgical benefits of combined awake craniotomy and intraoperative magnetic resonance imaging for gliomas associated with eloquent areas.
abstract: OBJECTIVE Maximum extent of resection (EOR) for lower-grade and high-grade gliomas can increase survival rates of patients. However, these infiltrative gliomas are often observed near or within eloquent regions of the brain. Awake surgery is of known benefit for the treatment of gliomas associated with eloquent regions in that brain function can be preserved. On the other hand, intraoperative MRI (iMRI) has been successfully used to maximize the resection of tumors, which can detect small amounts of residual tumors. Therefore, the authors assessed the value of combining awake craniotomy and iMRI for the resection of brain tumors in eloquent areas of the brain. METHODS The authors retrospectively reviewed the records of 33 consecutive patients with glial tumors in the eloquent brain areas who underwent awake surgery using iMRI. Volumetric analysis of MRI studies was performed. The pre-, intra-, and postoperative tumor volumes were measured in all cases using MRI studies obtained before, during, and after tumor resection. RESULTS Intraoperative MRI was performed to check for the presence of residual tumor during awake surgery in a total of 25 patients. Initial iMRI confirmed no further tumor resection in 9 patients (36%) because all observable tumors had already been removed. In contrast, intraoperative confirmation of residual tumor during awake surgery led to further tumor resection in 16 cases (64%) and eventually an EOR of more than 90% in 8 of 16 cases (50%). Furthermore, EOR benefiting from iMRI by more than 15% was found in 7 of 16 cases (43.8%). Interestingly, the increase in EOR as a result of iMRI for tumors associated mainly with the insular lobe was significantly greater, at 15.1%, than it was for the other tumors, which was 8.0% (p = 0.001). CONCLUSIONS This study revealed that combining awake surgery with iMRI was associated with a favorable surgical outcome for intrinsic brain tumors associated with eloquent areas. In particular, these benefits were noted for patients with tumors with complex anatomy, such as those associated with the insular lobe.
authors.affiliation: Department of Neurosurgery, Nagoya University School of Medicine, Nagoya.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Motomura
authors.affiliation: Department of Neurosurgery, Nagoya University School of Medicine, Nagoya.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Natsume
authors.affiliation: Department of Neurosurgery, Nagoya University School of Medicine, Nagoya.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Iijima
authors.affiliation: Department of Neurosurgery, Nagoya University School of Medicine, Nagoya.
authors.forename: Shunichiro
authors.initials: S
authors.lastname: Kuramitsu
authors.affiliation: Department of Neurosurgery, Fukushima Medical University, Fukushima.
authors.forename: Masazumi
authors.initials: M
authors.lastname: Fujii
authors.affiliation: Department of Neurosurgery, Nagoya University School of Medicine, Nagoya.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Brain and Mind Research Center, Nagoya University Graduate School of Medicine; and.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Maesawa
authors.affiliation: Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Sugiura
authors.affiliation: Department of Neurosurgery, Nagoya University School of Medicine, Nagoya.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Wakabayashi
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D002540:Cerebral Cortex / Q000000981:diagnostic imaging*; D003399:Craniotomy / Q000379:methods*; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D018365:Neoplasm, Residual; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D014851:Wakefulness
keywords: EOR = extent of resection; OS = overall survival; awake craniotomy; eloquent area; extent of resection; glioma; iMRI = intraoperative MRI; intraoperative magnetic resonance imaging; oncology; volumetric analysis