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

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

Radiology and Oncology
Volume 57 (2023): Issue 2 (June 2023)
By:
Open Access
|Jun 2023

Figures & Tables

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 patients24
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/reoperation22/2
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
DOI: https://doi.org/10.2478/raon-2022-0052 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
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Language: English
Page range: 191 - 200
Submitted on: Oct 9, 2022
Accepted on: Nov 2, 2022
Published on: Jun 21, 2023
Published by: Association of Radiology and Oncology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 times per year
Keywords:
awake craniotomy,
surgery of gliomas,
intraoperative neurophysiological testing,
primary brain tumours,
clinical experiences
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Haematology, oncology,
Radiology

© 2023 Tilen Zele, Tomaz Velnar, Blaz Koritnik, Roman Bosnjak, Jasmina Markovic-Bozic, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution 4.0 License.

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