Brain Functional Networks and Awake Craniotomy for Gliomas

Abstract

The sophisticated functional networks of the human brain are integral to life, controlling domains such as language understanding and production and social cognition, which are important for inter-personal communication. Glioma, a primary brain tumor, infiltrates into the brain tissue, forcing the normal brain to reorganize the neural networks(brain plasticity)to resist the invasion. Awake craniotomy for gliomas enables reliable intraoperative identification and preservation of not only the innate normal brain functional areas but also the brain functional networks that have adapted and changed in response to the tumor-invasive environment. Recent advances in neurosurgical techniques and anesthetics have enabled the performance of intraoperative mapping of various brain functions, while maintaining the patient at a high level of awake condition. Attempts have also been made to preserve not only the language functions in the left cerebral hemisphere but also the higher brain functions represented by the right frontal lobe. Herein, we introduce the neural networks of the brain that glioma surgeons need to be aware of, and further describe the indications, methods, and usefulness of awake craniotomy for preserving these networks. In addition, we will discuss topics expected to become the standard in the near future.