Functional Integrity by Using Intraoperative Mapping and Monitoring

Chapter 7 - Surgery, Indications and Limitations

Our understanding about certain brain modalities like language and its regional distribution has changed substantially over recent years.

Due to large interindividual differences, functional eloquence cannot be determined by anatomical landmarks alone.

All imaging methods have the great disadvantage that they do not provide information about brain functioning during tumour resection.

The gold standard to obtain reliable information about functionally relevant areas within the brain remains intraoperative neurophysiological examination.

Brain mapping and monitoring via (sub)cortical stimulation allows for the determination of eloquent areas at every time point during surgery.

Higher rates for extent of resection can be achieved more safely in gliomas of different World Health Organization grades by using these neurophysiological techniques.

Higher cognitive functions cannot be monitored in anaesthetised patients. However, awake surgery allows for localisation of language, calculation or spatial orientation.

According to special protocols, certain preoperatively trained tasks, like picture naming, can be tested safely in awake patients to detect aphasic disorders.

Triggered by the presentation of a task, the (sub)cortical surface is irritated by a standardised electrophysiological stimulation, possibly leading to functional disorders.

Revision Questions

  1. Why should intraoperative mapping and monitoring be used for glioma surgery?
  2.  Describe the indications for awake surgery of intracerebral tumours.
  3. How can patients be tested reliably during awake surgery?

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Last update: 18 September 2017