Naslov
Dilemmas in awake neurosurgery in patients with diffuse infiltrative brain tumors

Autori
Bujan Kovač, Andreja ; Mrak, Goran ; Gabelić Tereza ; Vodanović, Dinah ; Desnica, Andrej ; Nemir, Jakob ; Crnošija, Luka ; Šprljan Alfirev, Rujana ; Stambolija, Vasilije ; Lozić, Marin ; Petelin Gadže, Željka ; Nanković, Sibila ; Šulentić, Vlatko ; Bilić, Ervina ; Poljaković, Zdravka ; Jurjević, Ivana ; Nimac Kozina, Petra ; Hajnšek, Sanja

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, stručni

Izvornik
Neurologia Croatica. Supplement, 67 (2018), 1 / - , 2018, 12-13

Skup
6. hrvatski kongres "Dileme u neurologiji"

Mjesto i datum
Poreč, Hrvatska, 02.10.2018. - 06.10.2018

Vrsta sudjelovanja
Pozvano predavanje

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
awake neurosurgery ; diffuse infiltrative brain tumors

Sažetak
Gliomas are the most common primary brain tumors, which include a variety of different histologic tumor types and malignancy grades. Neurosurgical resection is the standard therapeutic procedure in multimodal treatment plan, based on the goal of achieving maximal tumor resection without inducing new neurologic deficits. However, brain tumors located within or in the proximity to critical functional areas, such as eloquent cortical regions (insula, rolandic and left perisylvian cortex) or tumors located near internal capsule and basal ganglia still bear a high risk of surgery related deficits such as dysphasia, neglect or motor deficit. In the last decades, we have witnessed improvement in neuroradiology, neurophysiology, neuroanesthesiology, neurosurgery and brain mapping techniques, which have allowed intraoperative monitoring in awake patients with direct electrical stimulation (DES). DES allows direct and real-time investigation of individual functional connectivity of the brain, not only for cortical regions, but also for subcortical mapping of sensorimotor, visuospatial, language and socio- cognitive pathways and their interactions. Multimodal systems such as working memory, attention, executive functions and consciousness can also be investigated by axonal stimulation. Coordinated teamwork and multimodal approach tailored for each patient is required, which includes preoperative functional mapping and planning, intraoperative monitoring and postoperative follow-up by a team consisting of surgeon, anesthesiologist, neurologist, speech therapist, neuropsychologist and neurophysiologist. Following this postulate, we can minimize permanent postoperative deficits while maximizing the extent of resection, especially in cases of infiltrative tumors such as low-grade gliomas, which implies shorter recovery to normal social and professional life with better patient survival and quality of life. Our experiences and dilemmas in awake brain surgery in patients with diffuse infiltrative brain tumors will be presented.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA