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2019, Number 4

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Cir Cir 2019; 87 (4)

Awake surgery with cortical-subcortical mapping in diffuse gliomas adjacent to central lobe. Report of two cases and literature review

Núñez-Velasco S, Avendaño-Méndez-Padilla J, García-Iturbide R, Pech-Cervantes CH, Molina-Martínez CA, Mejía-Pérez S

Language: Spanish
References: 25
Page: 459-465
PDF size: 457.28 Kb.


ABSTRACT

Introduction: Diffuse gliomas are brain neoplasms with an infiltrative growing pattern to cortical and subcortical structures, frequently adjacent to eloquent areas; direct cortical and subcortical stimulation in awake craniotomy is a useful tool to achieve a gross total resection with the least neurological deficit. Presentation of Cases: A 24 years old male presented with tonic-clonic seizures. The magnetic resonance imaging (MRI) showed a left parietal glioma. Awake craniotomy was performed using neuronavigation system and brain mapping with cortical and subcortical stimulation. Functional areas were found at the rostral margin of the tumor; however, the rest of the tumor was almost totally resected. Patient was discharged without neurological deficit. A 29 years old male presented in two occasions generalized tonic-clonic seizures, with right hemiparesis. The MRI showed a left parietal glioma. Awake craniotomy was performed using neuronavigation system and brain mapping with cortical and subcortical stimulation, achieving a gross total resection. Patient was discharged without neurological deficit. Conclusions: Awake craniotomy with brain mapping by cortical and subcortical stimulation and neuronavigation, are the best assets to treat diffuse gliomas and achieve a gross total resection, ensuring the major disease-free interval and preserving the function of eloquent areas.


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