AWAKE CRANIOTOMY WITH INTRAOPERATIVE BRAIN MAPPING: PRINCIPLES, TECHNIQUE AND OUTCOMES IN SURGERY FOR TUMORS OF ELOQUENT BRAIN AREAS
Abstract
Background: Surgery for intrinsic brain tumors must balance the extent of resection against the preservation of neurological function. Awake craniotomy with direct electrical stimulation mapping allows the surgeon to identify language, motor and sensory pathways in real time. Aim: To review the history, patient selection, anesthetic management, mapping technique and clinical outcomes of awake craniotomy for tumors located in or near eloquent brain. Methods: Narrative review of key clinical series, meta-analyses and technical reviews. Results: In the largest language-mapping series, only 1.6% of surviving patients (4 of 243) had a persistent language deficit at six months, and most series report a mean extent of resection above 90% or a gross total resection rate above 50%. Failure of the awake procedure is uncommon (0.5–6.4%). Evidence comparing awake surgery with general anesthesia comes almost entirely from non-randomized studies. Conclusion: Awake craniotomy with cortical and subcortical mapping is regarded as the gold standard for the maximal safe resection of tumors in or near eloquent brain.
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