title: "Next Door" intraoperative magnetic resonance imaging for awake craniotomy: Preliminary experience and technical note.
abstract: BACKGROUND
  During glioma surgery "maximal safe resection" must be the main goal. Intraoperative magnetic resonance imaging (iMRI) associated with awake craniotomy (AC) is a valuable tool to achieve this objective. In this article, AC with a "next-door" iMRI concept is described in a stepwise protocol.
  
  
  METHODS
  This is a retrospective analysis of 18 patients submitted to AC using iMRI; a stepwise protocol is also discussed.
  
  
  RESULTS
  The mean age was 41.7 years. Hemiparesis, aphasia, and seizures were the main initial symptoms of the patients. Sixty-six percent of the tumors were located in the left hemisphere. All tumors were near or within eloquent areas. Fifty-three percent of the cases were glioblastomas multiforme and 47% of the patients had low grade gliomas. The mean surgical time and iMRI time were 4 h 4 min and 30 min, respectively. New resection was performed in 33% after iMRI. Extent of resection (EOR) higher than 95% was possible in 66.7% of the patients. The main reason of EOR lower than 95% was positive mapping of eloquent areas (6 patients). Eighty percent of the patients experienced improvement of their deficits immediately after the surgery or had a stable clinical status whereas 20% had neurological deterioration, however, all of them improved after 30 days.
  
  
  CONCLUSIONS
  AC associated with "next-door" iMRI is a complex procedure, but if performed using a meticulous technique, it may improve the overall tumor resection and safety of the patients.
authors.affiliation: Neurosurgery Division, State University of Campinas, Unicamp, Sírio-Libranês, Brazil; Neurosurgery Division, Sírio-Libranês Hospital, Sírio-Libranês, Brazil.
authors.forename: Roger Neves
authors.initials: RN
authors.lastname: Mathias
authors.affiliation: Neurosurgery Division, Sírio-Libranês Hospital, Sírio-Libranês, Brazil; Neurosurgery Division, Santa Paula Hospital, Santa Paula, USA.
authors.forename: Paulo Henrique Pires
authors.initials: PH
authors.lastname: de Aguiar
authors.affiliation: Neurosurgery Division, State University of Campinas, Unicamp, Sírio-Libranês, Brazil.
authors.forename: Evandro Pinto
authors.initials: EP
authors.lastname: da Luz Oliveira
authors.affiliation: Neurosurgery Division, Sírio-Libranês Hospital, Sírio-Libranês, Brazil.
authors.forename: Silvia Mazzali
authors.initials: SM
authors.lastname: Verst
authors.affiliation: Department of Anesthesiology, Sírio-Libranês Hospital, Sírio-Libranês, Brazil.
authors.forename: Vinícius
authors.initials: V
authors.lastname: Vieira
authors.affiliation: Department of Radiology, Sírio-Libranês Hospital, Sírio-Libranês, Brazil.
authors.forename: Marcos Fernando
authors.initials: MF
authors.lastname: Docema
authors.affiliation: Neurosurgery Division, State University of Campinas, Unicamp, Sírio-Libranês, Brazil; Neurosurgery Division, Sírio-Libranês Hospital, Sírio-Libranês, Brazil; Neurosurgery Division, Santa Paula Hospital, Santa Paula, USA.
authors.forename: Marcos Vinícius
authors.initials: MV
authors.lastname: Calfat Maldaun
keywords: Awake craniotomy; glioblastoma multiforme; intraoperative magnetic resonance imaging; low grade gliomas