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Background: Results of awake craniotomy are compared to results of resections done under general anesthesia in patients operated with IMRI control. We hypothesized that stimulation of the cortex and white matter during awake surgery supplements IMRI control allowing for safer resection of eloquent brain area tumors., Methods: The study group consisted of 20 consecutive patients undergoing awake craniotomy with IMRI control. Resection outcome of these patients was compared to a control group of 20 patients operated in the same IMRI suite but under general anesthesia without cortical stimulation. The control group was composed of those patients whose age, sex, tumor location, recurrence and histology best matched to patients in study group., Results: Cortical stimulation identified functional cortex in eight patients (40 %). Postoperatively the neurological condition in 16 patients (80 %) in the study group was unchanged or improved compared with 13 patients (65 %) in the control group. In both groups, three patients (15 %) had transient impairment symptoms. There was one patient (5 %) with permanent neurological impairment in the study group compared to four patients (20 %) in the control group. These differences between groups were not statistically significant. There was no surgical mortality in either group and the overall infection rate was 5 %. Mean operation time was 4 h 45 min in the study group and 3 h 15 min in the control group., Conclusions: The study consisted of a limited patient series, but it implies that awake craniotomy with bipolar cortical stimulation may help to reduce the risk of postoperative impairment following resection of tumors located in or near speech and motor areas also under IMRI control.

Analysis of resting-state functional magnetic resonance imaging (fMRI) data is based on detecting low-frequency signal fluctuations in functionally connected brain areas. These synchronous fluctuations in resting-state networks have been observed in several studies with healthy subjects. In this study, we explored if independent component analysis (ICA) can be used to localize the sensorimotor area from resting-state fMRI data in patients with brain tumors. Finger-tapping activation task and resting-state blood-oxygenation-level-dependent fMRI data were acquired from 8 patients with brain tumors and 10 healthy volunteers. Sensorimotor task independent components (IC(task)) were used to verify resting-state independent components (IC(rest)) individually. In addition, sensorimotor IC(rest)s were compared between the groups and no significant differences were detected in volume, spatial correlation or temporal correlation. These results show that it is possible to localize a sensorimotor area from resting-state data using ICA in patients with brain tumors. This offers a complementary method for assessing the sensorimotor area in subjects with brain tumors who have difficulties in performing motor paradigms.