Intraoperative neuropsychological testing (IONT) is a sophisticated method of cognitive mapping during the resection of brain tumors in eloquent areas. Direct electrical stimulation during awake craniotomy is routinely utilized for mapping basic language and sensorimotor function, but the utilization of IONT offers an individualized approach that can yield real-time, comprehensive feedback on various cognitive functions, allowing for a tailored and more extensive tumor resection. In this video, the authors present the case of a 41-year-old male undergoing re-resection for a recurrent right temporal astrocytoma in which IONT played a crucial role. The video can be found here: https://stream.cadmore.media/r10.3171/2024.10.FOCVID24128.

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Intraoperative neuropsychological testing (IONT) is a sophisticated method of cognitive mapping during the resection of brain tumors in eloquent areas. Direct electrical stimulation during awake craniotomy is routinely utilized for mapping basic language and sensorimotor function, but the utilization of IONT offers an individualized approach that can yield real-time, comprehensive feedback on various cognitive functions, allowing for a tailored and more extensive tumor resection. In this video, the authors present the case of a 41-year-old male undergoing re-resection for a recurrent right temporal astrocytoma in which IONT played a crucial role.

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Arcuate fasciculus cortico-cortical evoked potentials and direct cortico-subcortical stimulation during awake craniotomy for debulking of left dominant temporal oligodendroglioma.

Neurosurg Focus Video

January 2025

Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia; and.

Electrophysiological mapping and monitoring techniques permit the objective measurement of eloquent cortical regions and accompanying white matter tracts to reduce the incidence of iatrogenic injury in glioma surgery. Recently, there has been increased interest in mapping and monitoring of the human arcuate fasciculus via cortico-cortical evoked potentials (CCEPs) during awake and asleep craniotomy. The authors present the case of a 27-year-old female who underwent a hypnosis-assisted awake craniotomy with cortico-subcortical language mapping and arcuate fasciculus CCEPs.

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Awake craniotomy (AC) facilitates real-time brain mapping, maximizing tumor resection while preserving critical neurological functions. This study systematically reviews the efficacy of several anesthetic protocols under Monitored Anesthesia Care (MAC) during AC, focusing on clinical outcomes. A systematic review and meta-analysis were conducted using data from observational studies and randomized trials involving AC under MAC.

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Target populationAdults with imaging suggestive of a WHO grade II diffuse gliomas (oligodendrogliomas or astrocytomas)QuestionIn adults with imaging suggestive of a WHO grade II diffuse gliomas (oligodendrogliomas or astrocytomas), does surgical resection improve overall survival compared to observation or biopsy?Updated Recommendation from the Prior Version of These Guidelines:Level III: In adults with imaging suggestive of a WHO grade II diffuse gliomas (oligodendrogliomas or astrocytomas), surgical resection is suggested over observation or biopsy to improve overall survival.Question Q2In adults with imaging suggestive of a WHO grade II diffuse gliomas (oligodendrogliomas or astrocytomas), does maximal surgical resection improve progression free survival (PFS) and overall survival (OS) compared to subtotal resection/biopsy?Unchanged Recommendations from the Prior Version of These GuidelinesLevel II It is recommended that GTR or STR be accomplished instead of biopsy alone when safe and feasible so as to decrease the frequency of tumor progression recognizing that the rate of progression after GTR is fairly high.Level III Greater extent of resection can improve OS in WHO grade II diffuse gliomas patients.

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