Search

The sophisticated functional networks of the human brain are integral to life, controlling domains such as language understanding and production and social cognition, which are important for inter-personal communication. Glioma, a primary brain tumor, infiltrates into the brain tissue, forcing the normal brain to reorganize the neural networks(brain plasticity)to resist the invasion. Awake craniotomy for gliomas enables reliable intraoperative identification and preservation of not only the innate normal brain functional areas but also the brain functional networks that have adapted and changed in response to the tumor-invasive environment. Recent advances in neurosurgical techniques and anesthetics have enabled the performance of intraoperative mapping of various brain functions, while maintaining the patient at a high level of awake condition. Attempts have also been made to preserve not only the language functions in the left cerebral hemisphere but also the higher brain functions represented by the right frontal lobe. Herein, we introduce the neural networks of the brain that glioma surgeons need to be aware of, and further describe the indications, methods, and usefulness of awake craniotomy for preserving these networks. In addition, we will discuss topics expected to become the standard in the near future.

Background: Stereotactic brain biopsy using a navigation system is minimally invasive because it can be performed under local anesthesia. However, there are problems due to the localization and accessibility of the tumor and instability of the airway under sedation. This study aimed to examine the differences in safety and surgical time between the supine and lateral position., Methods: This study included 25 cases which underwent navigation-guided brain biopsies from May 2015 to March 2018 in the Kanazawa University Hospital. We compared tumor localization, operation time, standby time, intraoperative difficulties, and final diagnosis acquisition rates between the supine and lateral positions. Puncture sites were then examined by visualizing all biopsy trajectories simultaneously on a three-dimensional cerebral template., Results: Biopsies of the tumor in all cerebrum lobes were possible in the lateral position. There were no significant differences in operating time or standby time between the supine and lateral positions. One case in the spine position required sedation by an anesthesiologist due to body movement, but there were no difficulties in any cases of lateral positioning. The final diagnosis acquisition rate was 100% in all cases. In the lateral position, stable breathing was maintained because the head and the trunk axes remined in the same line., Conclusion: Stereotactic brain biopsy in the lateral position can be safer and more useful than in the supine position under local anesthesia.

Awake surgery for lesions in the non-dominant parietal lobe is rare. We report two cases of right parietal lobe glioma for which awake surgery was performed in order to avoid ataxie optique and hemispatial neglect due to injury in the superior and inferior parietal lobule, respectively. Among several tests to assess the dysfunction of spatial recognition, line bisection test was selected for the task during awake surgery because of its simplicity, easy repetition, and utility. The tumor was successfully removed without any neurological deficit in both the cases. The line bisection test is simple and useful for preserving spatial recognition during an awake surgery.