J Neurol Surg A Cent Eur Neurosurg 2015; 76 - A056
DOI: 10.1055/s-0035-1566375

Awake Craniotomy in Clinical Center of Vojvodina in Novi Sad

Petar Vuleković 1, Igor Horvat 1, Vedrana Karan 2, Sanja Vicković 3, Mladen Karan 1, Đula Đilvesi 1
  • 1Clinic of Neurosurgery, Clinical Center of Vojvodina, Novi Sad, Serbia
  • 2Department of Physiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
  • 3Clinic of anesthesia and intensive care, Clinical Center of Vojvodina, Novi Sad, Serbia

Introduction Resection or even biopsy of an intra-axial tumor in close relationship to eloquent cortex carries a major risk of neurological deficit. We have assessed the safety and effectiveness of awake craniotomy under local anesthesia and monitored conscious sedation for the resection of tumors involving speech and motor cortex. The key advantage of awake techniques is the ability to assess the patient's neurological status during surgery and ensuring intraoperative cooperation with patient.

Aim To assess the possibility and effectiveness of awake craniotomy for the tumor resection in eloquent areas.

Material and Methods We have performed a retrospective review of a consecutive series of five adult patients who underwent awake craniotomy under local anesthesia at Clinic of Neurosurgery, Clinical Center of Vojvodina, during the first 6 months of the year 2015. All patients had tumors in close proximity to eloquent cortex, including speech and motor area, and also arcuate fasciculus stretched by peritumoral edema. Three patients had motor aphasia and contralateral hemiparesis, while the other two patients suffered from sensorimotor aphasia with contralateral hemiparesis.

Results Radiologically confirmed gross total resection was achieved in three patients despite the close relationship of tumor to the eloquent cortex. The other two patients had the maximum reduction performed, which was mainly influenced by the position of the tumor. In all cases, brain mapping was performed to identify eloquent areas such as Broca, Wernicke, and primary motor cortex. Four of the patients cooperated completely during the procedure, while the fifth patient had to be sedated by the end of the procedure due to subjective discomfort.

Conclusion Awake craniotomy in tumor surgery is a safe and a well-tolerated procedure that allows maximal resection of lesions in close anatomical relationship to the eloquent cortex, with a low risk of developing a new neurological deficit.

Keywords awake craniotomy; eloquent cortex; tumor resection