BACKGROUND: Surgical removal of perirolandic glioma tumors aims at maximal tumor resection while preserving motor function. The potential benefit of resection using pre and intraoperative brain mapping techniques either under awake craniotomy or general anesthesia (GA) for motor preservation is yet unidentified.
OBJECTIVE: To evaluate the clinical outcomes of patients who underwent surgery for perirolandic tumors while either awake or under GA.
METHODS: We evaluated 24 patients in the period between 2017 and 2019, had undergone resection of hemispheric perirolandic gliomas within or adjacent to descending motor pathways, preoperative brain mapping with functional MRI (FMRI) and Diffuse Tensor Imaging (DTI) and intraoperative mapping with direct cortical subcortical stimulation for awake craniotomy cases or transcorical/subcortical motor evoked potential (TcMEP,TscMEP) Neuromonitoring for G.A cases.
Results: Results showing that with direct cortical subcortical stimulation for both awake and general anaesthetized craniotomy achieved gross total resection in 45.7%, and study technique was associated with early postoperative new or worsened deficit in (29.2%) which remained permanent after 3 months in only in (8.3%).
Conclusions: Brain mapping allows surgeons to identify the descending motor pathways during resection of tumors in perirolandic regions and to attain an acceptable rate of morbidity in these high-risk cases.