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Awake craniotomy for operative treatment of brain gliomas – experience from University Medical Centre Ljubljana

Tilen Zele

Tilen Zele

Department of Neurosurgery, University Medical Centre LjubljanaLjubljana, Slovenia
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Zele, Tilen
, 
Tomaz Velnar

Tomaz Velnar

Department of Neurosurgery, University Medical Centre LjubljanaLjubljana, Slovenia
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Velnar, Tomaz
, 
Blaz Koritnik

Blaz Koritnik

Department of Neurophysiology, University Medical Centre LjubljanaLjubljana, Slovenia
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Koritnik, Blaz
, 
Roman Bosnjak

Roman Bosnjak

Department of Neurosurgery, University Medical Centre LjubljanaLjubljana, Slovenia
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Bosnjak, Roman
 y 
Jasmina Markovic-Bozic

Jasmina Markovic-Bozic

Department of Anaesthesiology and Intensive Care, University Medical Centre Ljubljana, Department of Anesthesiology and Reanimation Faculty of Medicine, University of LjubljanaLjubljana, Slovenia
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Markovic-Bozic, Jasmina
  
21 jun 2023
Awake craniotomy for operative treatment of brain gliomas – experience from University Medical Centre Ljubljana's Cover Image
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Categoría del artículo: Research Article
Publicado en línea: 21 jun 2023
Páginas: 191 - 200
Recibido: 09 oct 2022
Aceptado: 02 nov 2022
DOI: https://doi.org/10.2478/raon-2022-0052
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© 2023 Tilen Zele et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

Preoperative magnetic resonance images (MRI) of low-grade glioma located in primary motor cortex (A) and anaplastic astrocytoma located in anterior speech area (Broca area) (B). Preoperative imaging included T1 weighted contrast enhanced (A1, B1), T2 weighted (A2, B2), FLAIR (A3, B3) and functional magnetic resonance (fMRI); (A4, A5, B4, B5) images. The fMRI demonstrated the hand activation area (yellow/red colour) lateral (A4) and leg activation area behind (A5) the lesion in primary motor cortex. In second case fMRI demonstrated speech activation areas posterior to the lesion on the left side (B4, B5).
Preoperative magnetic resonance images (MRI) of low-grade glioma located in primary motor cortex (A) and anaplastic astrocytoma located in anterior speech area (Broca area) (B). Preoperative imaging included T1 weighted contrast enhanced (A1, B1), T2 weighted (A2, B2), FLAIR (A3, B3) and functional magnetic resonance (fMRI); (A4, A5, B4, B5) images. The fMRI demonstrated the hand activation area (yellow/red colour) lateral (A4) and leg activation area behind (A5) the lesion in primary motor cortex. In second case fMRI demonstrated speech activation areas posterior to the lesion on the left side (B4, B5).

Figure 2

Preoperative (A) and postoperative (B) T1 weighted contrast enhanced (A1, B1) and T2 weighted (A2, B2) magnetic resonance images (MRI) of glioblastoma located in supramarginal gyrus near Wernicke area. Preoperative images (A) demonstrate rim enhancing central necrotic oval lesion surrounded by oedema. Postoperative images (B) demonstrate post-resection cavity filled with partially haemorrhagic fluid and mild irregular contrast enhancing of resection edge – i.e. near total resection.
Preoperative (A) and postoperative (B) T1 weighted contrast enhanced (A1, B1) and T2 weighted (A2, B2) magnetic resonance images (MRI) of glioblastoma located in supramarginal gyrus near Wernicke area. Preoperative images (A) demonstrate rim enhancing central necrotic oval lesion surrounded by oedema. Postoperative images (B) demonstrate post-resection cavity filled with partially haemorrhagic fluid and mild irregular contrast enhancing of resection edge – i.e. near total resection.

Figure 3

The Karnowski Performance Scale (KPS) scores (A) and 36-Item Short Form (SF-36) health survey subscale scores (B) before surgery, after surgery and 3 months after surgery. The differences between the KPS scores and SF-36 subscale scores before and after surgery were not statistically significantly different (p > 0.05; n = 24 for KPS; n = 12 for SF-36).
The Karnowski Performance Scale (KPS) scores (A) and 36-Item Short Form (SF-36) health survey subscale scores (B) before surgery, after surgery and 3 months after surgery. The differences between the KPS scores and SF-36 subscale scores before and after surgery were not statistically significantly different (p > 0.05; n = 24 for KPS; n = 12 for SF-36).

Demographics and preoperative data

No. of patients 24
Age (years) 41 ± 11
Weight (kg) 81 ± 12
Height (cm) 176 ± 8
Gender (M/F) 18/6
ASA (I/II/III) 9/15/0
First operation/reoperation 22/2
Tumour size (cm3) 46 ± 27
Tumour location (side):
  Insular (left/right) 4/3
  Frontal Central-PMC (left/right) 2/2
  Frontal-Broca area (left/right) 6/1
  Temporo-frontal (left/right) 3/0
  Temporal-Wernicke area (left/right) 3/0

Intraoperative and early postoperative outcomes

INTRAOPERATIVE DATA
Duration of anaesthesia (minutes) 278 ± 47
Duration of procedure (minutes) 215 ± 48
Duration of testing (minutes) 73 ± 26
Comfort score (0- least; 10- most) 8 ± 2 (5–10)
Pain score (0- no pain; 10- intolerable) 4 ± 2 (0–5)
Cooperation score (0- poor; 10- excellent) 10 ± 1 (9–10)
Complications (none/seizure/incomplete testing) 13/8/3
Idioma:
Inglés
Calendario de la edición:
4 veces al año
Temas de la revista:
Medicina, Medicina Clínica, Medicina Interna, Hematología, oncología, Radiología
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