Intra-operative awake anaesthesia and functional localization for resection of glioma and epileptogenic foci in eloquent area

Abstract

Objective To investigate the surgical method and curative effect of intra-operative awake anaesthesia and functional localization for resection of glioma and epileptogenic foci in eloquent area.Methods Twenty-four consecutive patients with secondary epilepsy of glioma in eloquent area were treated with asleep-awake-asleep-technique.First,the craniotomy was performed under general anaesthesia with laryngeal mask.Then awake anaesthesia,functional mapping such as sensory,motion and language zone was judged by somatosensory evoked potential (SEP) and cortical electrical stimulation (CS),epileptogenic foci was localized by electrocorticography(ECoG) monitoring,assisted with intra-operative real-time ultra-sound to locate the anatomical boundary of the tumors.Surgical resect tumor and epileptogenic foci under awaking by intra-operative neurophysiologic monitoring(IOM).Last close the skull under general anaesthesia.Results All patients underwent asleep-awake-asleep successfully,and no painful and dread experience in the operations.Fifteen patients remaining laryngeal mask,9 patients pull out laryngeal mask and again inserting it after language mapping.Twenty patients' cerebral eloquent area were located by IOM,4 cases not found eloquent area.Ninteen cases discovered perilesional cortex of epileptogenic foci by ECoG monitoring and were performed by multiple subpial transaction (MST) and/or cortex lower output powers thermocoagulation.Tumors were total resected in 18 cases,most resection in 6 cases.The preoperative dysfunction aggravated in 13 cases postoperative three days,but all got a recovery and improvement gradually in one month.Sixteen cases epileptic seizure disappeared completely and 8 patients decreased obviously.Conclusions Awake anaesthesia combined with multiple modem location technique can maximum remove the tumor,effectively protect the neurologic function,and improve the curative effect of glioma in eloquent area. Key words: Eloquent area; Glioma; Secondary epilepsy ; Awake anaesthesia; Intra-operative neurophysiologic monitoring