Awake craniotomy in glioma surgery

Is it necessary?

Chase H. Foster, Peter J. Morone, Aaron Cohen-Gadol

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

INTRODUCTION: The awake craniotomy has evolved from its humble beginnings in ancient cultures to become one of the most eloquent modern neurosurgical procedures. The development of intraoperative mapping techniques like direct electrostimulation of the cortex and subcortical white matter have further argued for its place in the neurosurgeon’s armamentarium. Yet the suitability of the awake craniotomy with intraoperative functional mapping (ACWM) to optimize oncofunctional balance after peri-eloquent glioma resection continues to be a topic of active investigation as new methods of intraoperative monitoring and some unfavorable outcome data question its necessity. EVIDENCE ACQUISITION: The neurosurgery and anesthesiology literatures were scoured for English-language studies that analyzed or reviewed the ACWM or its components as applied to glioma surgery via the PubMed, ClinicalKey, and OvidMEDLINE® databases or via direct online searches of journal archives. EVIDENCE SYNTHESIS: Information on background, conceptualization, standard techniques, and outcomes of the ACWM were provided and compared. We parceled the procedure into its components and qualitatively described positive and negative outcome data for each. Findings were presented in the context of each study without attempt at quantitative analysis or reconciliation of heterogeneity between studies. Certain illustrative studies were highlighted throughout the review. Overarching conclusions were drawn based on level of evidence, expert opinion, and predominate concordance of data across studies in the literature. CONCLUSIONS: Most investigators and studies agree that the ACWM is the best currently available approach to optimize oncofunctional balance in this difficult-to-treat patient population. This qualitative review synthesizes the most currently available data on the topic to provide contemporaneous insight into how and why the ACWM has become a favorite operation of neurosurgeons worldwide for the resection of gliomas from eloquent brain.

Original languageEnglish (US)
Pages (from-to)162-178
Number of pages17
JournalJournal of Neurosurgical Sciences
Volume63
Issue number2
DOIs
StatePublished - Apr 1 2019

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Craniotomy
Glioma
Neurosurgical Procedures
Intraoperative Monitoring
Anesthesiology
Expert Testimony
Neurosurgery
PubMed
Language
Research Personnel
Databases
Brain
Population

Keywords

  • Brain mapping
  • Craniotomy
  • Glioma

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Awake craniotomy in glioma surgery : Is it necessary? / Foster, Chase H.; Morone, Peter J.; Cohen-Gadol, Aaron.

In: Journal of Neurosurgical Sciences, Vol. 63, No. 2, 01.04.2019, p. 162-178.

Research output: Contribution to journalReview article

Foster, Chase H. ; Morone, Peter J. ; Cohen-Gadol, Aaron. / Awake craniotomy in glioma surgery : Is it necessary?. In: Journal of Neurosurgical Sciences. 2019 ; Vol. 63, No. 2. pp. 162-178.
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