Clinical analysis of surgery for tumors and secondary epileptogenic foci in eloquent cortex under awake anesthesia

Abstract

Objective To investigate the indication,operative main points of resection of tumor and epileptogenic foci in eloquent cortical area and its curative effect under intra-operative awake anaesthesia.Methods Forty-nine consecutive patients suffering from epilepsy secondary to gliomas (n=33) and meningomas (n=16) in eloquent area,admitted to our hospital from June 2006 to June 2012,were chosen in our study.MRI was employed to detect the location of the tumors; diffusion tensor imaging (DTT) was used to display the location of white matter fiber tracts with the tumor,and functional magnetic resonance imaging (fMRI) was used to detect the motion functional zone; the epileptogenic foci and the anatomical boundary of the tumors were localized by electrocorticography (ECoG) monitoring and real-time ultrasound,respectively; microneurosurgery was under asleep-awake-asleep-technique performed to resect the tumors and epileptogenic foci.Results Forty-four patients underwent surgery under asleep-awake-asleep,successfully,including 28 remaining laryngeal mask,16 pulling out laryngeal mask and again inserting it after language mapping.Five old patients gave up awake-anaesthesia because of restlessness,breath holding and brain tissue being bulged severely.The cerebral functional zones of 36 patients were located by IOM and 8 were without noting eloquent area.Epileptogenic foci were discovered in 31 patients by ECoG monitoring.Gliomas total resection was achieved in 22,and subtotal resection in 8.Meningoma total resection was achieved in 13 and subtotal resection in 1.No seizures happened during the operations.The temporary or new dysfunctions aggravated in 26 after the operation,but all got recovery in one month.All patients' dysfunction got an improvement obviously.Epileptic seizure disappeared completely in 31 patients and decreased obviously in 13 patients.Conclusion Surgery of tumors and epileptogenic foci in eloquent cortical area under awake-anaesthesia can maximally remove the tumors safely,protect cerebral function maximally and treat secondary epileptogenic foci safely; selection of preoperative indications,intra-operative proper operative position and effective prevention of epileptic seizure are the keys of success surgery. Key words: Cerebral functional area; Tumor; Secondary epilepsy; Awake anaesthesia; Intra-operative neurophysiologic monitoring; Electrocorticography