Abstract
Recent advances in our understanding of cortical and subcortical organization of basic neural functions in the human brain as well as technical advances in brain mapping have allowed an increased extent of resection while maintaining or even improving quality of life for glioma patients undergoing surgery. Thus the goal of intrinsic tumor surgery has changed from conservative lesionectomy or biopsy-based approaches to aggressive or supratotal resections bounded not by artificial MRI-based borders but rather by functional cortical and subcortical structures. Given that essentially any function important to the patient can be tested intraoperatively under awake conditions, in our experience awake mapping has become the rule rather than the exception for surgical resection of gliomas near eloquent areas, and the intraoperative tasks should be specifically designed to optimally balance oncologic (extent of resection) and functional (quality-of-life) considerations.
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