Role of Preoperative Functional Brain MRI and Awake Craniotomy in Surgeries for Gliomas in Eloquent Areas

Objective: The aim of this work is to evaluate the variable outcomes of surgical excision of gliomas in eloquent areas of the brain using pre-operative functional MRI-brain and awake craniotomy. Methods: Twelve patients having gliomas in eloquent areas of the brain were included in this study. Preoperative functional MRI brains were done for all patients and were operated under awake craniotomy. Operative procedures included tumor debulking, subtotal resection, and gross total resection. Postoperatively, patients were evaluated and followed-up for their neurological integrity, deficits and outcome. Results: The median age of presentation in this study was 38 year. There was 8 males (67%) and 4 females (33%). In this study the main presentation of patients was headache (100%), followed by seizures in 6 patients (50%), followed by contra-lateral motor weakness in 4 patients (33%), and followed by dysphasia in 2 patients (17%). The most commonly involved lobe was the frontal lobe where it was involved in 6 patients (50%), followed by the temporal lobe in 4 patients (33%), followed by the parietal lobe in 2 patients (17%). We achieved gross total resection in 8 patients (67%), tumor debulking in two patients (17%), and subtotal resection in two patients (17%). Postoperatively, 1 patient (8%) had transient new onset motor weakness. Out of the 4 patients presented with pre-operatively motor weakness, two patients (50%) had further deterioration of motor power. Regarding speech, one patient (8%) had new onset expressive dysphasia. Out of the two patients (8%) that originally presented with dysphasia, one patient (50%) had further deterioration of speech up to global aphasia, and was permanent. Out of the patients eight patients had excellent outcomes (67%), two patients (17%) had good outcomes, onepatient (8%) had a fair outcome, and 1 patient (8%) had a poor outcome. Conclusion: Individualized preoperative neuroimaging, including FMRI and DTI followed by an awake craniotomy may be able to maximize the extent of resection and preserve long-term neurological function.