Awake craniotomy for aggressive resection of primary gliomas located in eloquent brain

Fredric B. Meyer, Lisa M. Bates, Stephan J. Goerss, Jonathan A. Friedman, Wanda L. Windschitl, Joseph R. Duffy, William J. Perkins, Brian Patrick O'Neill

Research output: Contribution to journalArticle

147 Citations (Scopus)

Abstract

• Objective: To determine with intraoperative neurologic and language examinations the maximal tumor resection achievable with acceptable postoperative neurologic dysfunction in patients undergoing awake stereotactic glial tumor resection in eloquent regions of the brain. • Patients and Methods: Between October 1995 and December 2000, 65 patients underwent frameless stereotactic resection of glial tumors located in functioning tissue. During the resection, continuous examinations by a neurologist and speech pathologist were performed. The goal of surgery was to resect the maximum neurologically permissible tumor volume defined on preoperative T2 imaging. Tumor resection was stopped at the onset of neurologic dysfunction. Novel segmentation software was used to measure tumor cytoreduction based on pre- and postoperative magnetic resonance imaging. All patients underwent 3-month postoperative neurologic examinations to determine functional outcomes. • Results: The cortical and subcortical white matter tracts at risk for injury were the left frontal operculum in 15 patients, the central lobule in 38, the insula in 11, and the left angular gyrus in 1. Thirty-four (52%) had a greater than 90% reduction in T2 signal postoperatively. In 26 patients thought to have low-grade tumors based on preoperative imaging, 12 proved to have grade 3 gliomas. Forty-eight patients (74%) developed intraoperative deficits; 34 (71%) recovered to a modified Rankin grade of 0 or 1 at 3 months postoperatively, 11 (23%) achieved a modified Rankin grade of 2, and 3 patients (6%) achieved a modified Rankin grade of 3 or 4 at 3-month follow-up. There was no operative mortality; 17 patients (26%) died from tumor progression during the follow-up period. • Conclusions: Combining frameless computer-guided stereotaxis with cortical stimulation and repetitive neurologic and language assessments facilitates tumor resection in functioning brain regions. Resecting tumor until the onset of neurologic deficits allows for a good functional recovery. Imaging software can objectively and accurately measure preoperative and postoperative tumor volumes.

Original languageEnglish (US)
Pages (from-to)677-687
Number of pages11
JournalMayo Clinic Proceedings
Volume76
Issue number7
StatePublished - 2001

Fingerprint

Craniotomy
Glioma
Brain
Neoplasms
Neurologic Manifestations
Neurologic Examination
Tumor Burden
Neuroglia
Language
Software
Parietal Lobe
Nervous System
Magnetic Resonance Imaging
Mortality
Wounds and Injuries

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Meyer, F. B., Bates, L. M., Goerss, S. J., Friedman, J. A., Windschitl, W. L., Duffy, J. R., ... O'Neill, B. P. (2001). Awake craniotomy for aggressive resection of primary gliomas located in eloquent brain. Mayo Clinic Proceedings, 76(7), 677-687.

Awake craniotomy for aggressive resection of primary gliomas located in eloquent brain. / Meyer, Fredric B.; Bates, Lisa M.; Goerss, Stephan J.; Friedman, Jonathan A.; Windschitl, Wanda L.; Duffy, Joseph R.; Perkins, William J.; O'Neill, Brian Patrick.

In: Mayo Clinic Proceedings, Vol. 76, No. 7, 2001, p. 677-687.

Research output: Contribution to journalArticle

Meyer, FB, Bates, LM, Goerss, SJ, Friedman, JA, Windschitl, WL, Duffy, JR, Perkins, WJ & O'Neill, BP 2001, 'Awake craniotomy for aggressive resection of primary gliomas located in eloquent brain', Mayo Clinic Proceedings, vol. 76, no. 7, pp. 677-687.
Meyer FB, Bates LM, Goerss SJ, Friedman JA, Windschitl WL, Duffy JR et al. Awake craniotomy for aggressive resection of primary gliomas located in eloquent brain. Mayo Clinic Proceedings. 2001;76(7):677-687.
Meyer, Fredric B. ; Bates, Lisa M. ; Goerss, Stephan J. ; Friedman, Jonathan A. ; Windschitl, Wanda L. ; Duffy, Joseph R. ; Perkins, William J. ; O'Neill, Brian Patrick. / Awake craniotomy for aggressive resection of primary gliomas located in eloquent brain. In: Mayo Clinic Proceedings. 2001 ; Vol. 76, No. 7. pp. 677-687.
@article{5e52d755ae3f40efbbedaa14876dce50,
title = "Awake craniotomy for aggressive resection of primary gliomas located in eloquent brain",
abstract = "• Objective: To determine with intraoperative neurologic and language examinations the maximal tumor resection achievable with acceptable postoperative neurologic dysfunction in patients undergoing awake stereotactic glial tumor resection in eloquent regions of the brain. • Patients and Methods: Between October 1995 and December 2000, 65 patients underwent frameless stereotactic resection of glial tumors located in functioning tissue. During the resection, continuous examinations by a neurologist and speech pathologist were performed. The goal of surgery was to resect the maximum neurologically permissible tumor volume defined on preoperative T2 imaging. Tumor resection was stopped at the onset of neurologic dysfunction. Novel segmentation software was used to measure tumor cytoreduction based on pre- and postoperative magnetic resonance imaging. All patients underwent 3-month postoperative neurologic examinations to determine functional outcomes. • Results: The cortical and subcortical white matter tracts at risk for injury were the left frontal operculum in 15 patients, the central lobule in 38, the insula in 11, and the left angular gyrus in 1. Thirty-four (52{\%}) had a greater than 90{\%} reduction in T2 signal postoperatively. In 26 patients thought to have low-grade tumors based on preoperative imaging, 12 proved to have grade 3 gliomas. Forty-eight patients (74{\%}) developed intraoperative deficits; 34 (71{\%}) recovered to a modified Rankin grade of 0 or 1 at 3 months postoperatively, 11 (23{\%}) achieved a modified Rankin grade of 2, and 3 patients (6{\%}) achieved a modified Rankin grade of 3 or 4 at 3-month follow-up. There was no operative mortality; 17 patients (26{\%}) died from tumor progression during the follow-up period. • Conclusions: Combining frameless computer-guided stereotaxis with cortical stimulation and repetitive neurologic and language assessments facilitates tumor resection in functioning brain regions. Resecting tumor until the onset of neurologic deficits allows for a good functional recovery. Imaging software can objectively and accurately measure preoperative and postoperative tumor volumes.",
author = "Meyer, {Fredric B.} and Bates, {Lisa M.} and Goerss, {Stephan J.} and Friedman, {Jonathan A.} and Windschitl, {Wanda L.} and Duffy, {Joseph R.} and Perkins, {William J.} and O'Neill, {Brian Patrick}",
year = "2001",
language = "English (US)",
volume = "76",
pages = "677--687",
journal = "Mayo Clinic Proceedings",
issn = "0025-6196",
publisher = "Elsevier Science",
number = "7",

}

TY - JOUR

T1 - Awake craniotomy for aggressive resection of primary gliomas located in eloquent brain

AU - Meyer, Fredric B.

AU - Bates, Lisa M.

AU - Goerss, Stephan J.

AU - Friedman, Jonathan A.

AU - Windschitl, Wanda L.

AU - Duffy, Joseph R.

AU - Perkins, William J.

AU - O'Neill, Brian Patrick

PY - 2001

Y1 - 2001

N2 - • Objective: To determine with intraoperative neurologic and language examinations the maximal tumor resection achievable with acceptable postoperative neurologic dysfunction in patients undergoing awake stereotactic glial tumor resection in eloquent regions of the brain. • Patients and Methods: Between October 1995 and December 2000, 65 patients underwent frameless stereotactic resection of glial tumors located in functioning tissue. During the resection, continuous examinations by a neurologist and speech pathologist were performed. The goal of surgery was to resect the maximum neurologically permissible tumor volume defined on preoperative T2 imaging. Tumor resection was stopped at the onset of neurologic dysfunction. Novel segmentation software was used to measure tumor cytoreduction based on pre- and postoperative magnetic resonance imaging. All patients underwent 3-month postoperative neurologic examinations to determine functional outcomes. • Results: The cortical and subcortical white matter tracts at risk for injury were the left frontal operculum in 15 patients, the central lobule in 38, the insula in 11, and the left angular gyrus in 1. Thirty-four (52%) had a greater than 90% reduction in T2 signal postoperatively. In 26 patients thought to have low-grade tumors based on preoperative imaging, 12 proved to have grade 3 gliomas. Forty-eight patients (74%) developed intraoperative deficits; 34 (71%) recovered to a modified Rankin grade of 0 or 1 at 3 months postoperatively, 11 (23%) achieved a modified Rankin grade of 2, and 3 patients (6%) achieved a modified Rankin grade of 3 or 4 at 3-month follow-up. There was no operative mortality; 17 patients (26%) died from tumor progression during the follow-up period. • Conclusions: Combining frameless computer-guided stereotaxis with cortical stimulation and repetitive neurologic and language assessments facilitates tumor resection in functioning brain regions. Resecting tumor until the onset of neurologic deficits allows for a good functional recovery. Imaging software can objectively and accurately measure preoperative and postoperative tumor volumes.

AB - • Objective: To determine with intraoperative neurologic and language examinations the maximal tumor resection achievable with acceptable postoperative neurologic dysfunction in patients undergoing awake stereotactic glial tumor resection in eloquent regions of the brain. • Patients and Methods: Between October 1995 and December 2000, 65 patients underwent frameless stereotactic resection of glial tumors located in functioning tissue. During the resection, continuous examinations by a neurologist and speech pathologist were performed. The goal of surgery was to resect the maximum neurologically permissible tumor volume defined on preoperative T2 imaging. Tumor resection was stopped at the onset of neurologic dysfunction. Novel segmentation software was used to measure tumor cytoreduction based on pre- and postoperative magnetic resonance imaging. All patients underwent 3-month postoperative neurologic examinations to determine functional outcomes. • Results: The cortical and subcortical white matter tracts at risk for injury were the left frontal operculum in 15 patients, the central lobule in 38, the insula in 11, and the left angular gyrus in 1. Thirty-four (52%) had a greater than 90% reduction in T2 signal postoperatively. In 26 patients thought to have low-grade tumors based on preoperative imaging, 12 proved to have grade 3 gliomas. Forty-eight patients (74%) developed intraoperative deficits; 34 (71%) recovered to a modified Rankin grade of 0 or 1 at 3 months postoperatively, 11 (23%) achieved a modified Rankin grade of 2, and 3 patients (6%) achieved a modified Rankin grade of 3 or 4 at 3-month follow-up. There was no operative mortality; 17 patients (26%) died from tumor progression during the follow-up period. • Conclusions: Combining frameless computer-guided stereotaxis with cortical stimulation and repetitive neurologic and language assessments facilitates tumor resection in functioning brain regions. Resecting tumor until the onset of neurologic deficits allows for a good functional recovery. Imaging software can objectively and accurately measure preoperative and postoperative tumor volumes.

UR - http://www.scopus.com/inward/record.url?scp=0034954818&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034954818&partnerID=8YFLogxK

M3 - Article

VL - 76

SP - 677

EP - 687

JO - Mayo Clinic Proceedings

JF - Mayo Clinic Proceedings

SN - 0025-6196

IS - 7

ER -