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J Neurol Surg A Cent Eur Neurosurg 2017; 78(02): 105-112
DOI: 10.1055/s-0036-1584512
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Early Experience with Combining Awake Craniotomy and Intraoperative Navigable Ultrasound for Resection of Eloquent Region Gliomas

Aliasgar Moiyadi
1   Department of Neurosurgery, Tata Memorial Centre, Mumbai, India
,
Prakash Shetty
1   Department of Neurosurgery, Tata Memorial Centre, Mumbai, India
› Author Affiliations
Further Information

Publication History

14 October 2015

24 March 2016

Publication Date:
01 July 2016 (online)

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Abstract

Introduction Optimal resection of tumors in eloquent locations requires a combination of intraoperative imaging and functional monitoring during surgery. Combining awake surgery with intraoperative magnetic resonanceis logistically challenging. Navigable ultrasound (US) is a useful alternative in such cases.

Methods A total of 22 subjects with eloquent tumors were operated on (1 intended biopsy and 21 intended radical resections) using combined modality three-dimensional (3D) US and awake craniotomy with intraoperative clinical monitoring. We describe the technical details for these cases specifically addressing the feasibility of combining the two modalities.

Results US was used for resection control in 18 cases. There were technical limitations in three cases. Transient intraoperative worsening was encountered in eight, necessitating premature termination of the procedure. All patients tolerated the awake procedure well. Mean duration of the surgery was 3.2 hours. Radical resections were obtained in 14 of 18 where this was intended and in 12 of the 13 where there was no adverse intraoperative monitoring event prompting premature termination of the resection.

Conclusions Combining awake surgery with 3DUS is feasible and beneficial. It does not entail any additional surgical workflow modification or patient discomfort. This combined modality intraoperative monitoring can be beneficial for eloquent region tumors.

Keywords

intraoperative ultrasound - awake craniotomy - eloquent area tumors - combined modality
 

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