Introduction: Presence of glioma in dominant speech center places Neurosurgeons in a Dilemma. They struggle in providing maximum surgical resection while preserving the language function. We report single surgeon’s experience for lesions in language center at a single institution that performed awake craniotomy.
Methods: A retrospective analysis was done for patients who presented with lesions either in the dominant posterior inferior frontal lobe, anterior inferior parietal lobe or inferior to mid portion of the motor cortex who underwent awake craniotomy with speech mapping. Patient demographics, perioperative language deficit, presenting seizures, tumor characteristics, volumetric Extent of Resection (EOR), seizure control, and a number of days in the hospital.
Results: Fifty-two patients underwent awake craniotomy with speech mapping between 2005 and 2015 time period. Patients with contrast enhancing lesion had a mean EOR of 96.66 ± 2.57 % of the volume, while the mean EOR for non-contrast enhancing lesions using MRI FLAIR was 78.86 ± 5.15% of the volume (p < 0.001). Twenty Seven patients presented with speech deficit, 48% of these patients showed speech improvement after surgery (p = 0.049). Only 3 patients (5.7%) (p < 0.001) had new or worsened speech deficit Post operatively. Furthermore, 33 patients presented with seizures and 72% of these patients were seizure free at one year after surgery.
Conclusions: Our study shows that more extensive resection is possible in lesions located near or within language eloquent areas with a minimal rate of post-operative speech deficit. Furthermore, the grade of extent of resection achieved in this population shows a positive correlation for seizure control.
Patient Care: By doing awake craniotomy maximum surgical resection can be achieved in eloquent language area which improves their prognosis
Learning Objectives: 1. Extensive resection can be achieved in patient with lesions in eloquent language area using awake craniotomy with speech mapping in this case
2. Function can be preserved by doing awake craniotomy in eloquent language area
3. Seizure can be controlled after surgical resection