Awake Brain Mapping [Neurosurgery Wiki]

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====== Awake Brain Mapping ======

It has been demonstrated that [[brain mapping]] in an [[awake]] patient is a very reliable tool for brain tumor [[resection]], allowing us to maximize the [[extent of resection]] while minimizing the functional risk
((De Witt Hamer PC, Robles SG, Zwinderman AH, Duffau H, Berger MS. Impact
of intraoperative stimulation brain mapping on glioma surgery outcome: a metaanalysis. J Clin Oncol. 2012;30(20):2559-2565.)).

This methodology is becoming more and more popular, and different teams have introduced many new [[task]]s in their intraoperative battery, for motor functions
((Rossi M, Fornia L, Puglisi G, et al. Assessment of the praxis circuit in glioma surgery
to reduce the incidence of postoperative and long-term apraxia: a new intraoperative test. J Neurosurg. 2018;130(1):17-27.))
as well as for cognitive functions
((Skrap M, Marin D, Ius T, Fabbro F, Tomasino B. Brain mapping: a novel intraoperative neuropsychological approach. J Neurosurg. 2016;125(4):1-11.))
((Wager M, Du Boisgueheneuc F, Pluchon C, et al. Intraoperative monitoring of an
aspect of executive functions: administration of the Stroop test in 9 adult patients
during awake surgery for resection of frontal glioma. Neurosurgery. 2013;72(2
Suppl Operative):ons169-180; discussion ons180-181.)).


Awake [[brain mapping]] is not an additional [[surgical technique]] but an alternative philosophy in the management of [[Low-grade glioma]] patients
((Duffau H. Awake mapping is not an additional surgical technique but an
alternative philosophy in the management of low-grade glioma patients. Neurosurg 
Rev. 2017 Dec 13. doi: 10.1007/s10143-017-0937-6. [Epub ahead of print] PubMed
PMID: 29236183.
)).
----
During [[resection]] of [[intrinsic brain tumor]]s in [[eloquent area]]s, particularly under [[awake]] [[mapping]], subcortical [[stimulation]] is mandatory to avoid irreversible deficits by damaging [[white fiber tract]]s. The current practice is to alternate between subcortical stimulation with an appropriate [[probe]] and [[resection]] of [[tumor]]al [[tissue]] with an [[ultrasound]] [[aspiration]] [[device]]. Switching between different [[device]]s induces supplementary movement and possible tissue [[trauma]], loss of time, and inaccuracies in the localization of the involved area.

The tip of different ultrasound aspiration devices is currently used for [[monopolar]] current transmission (e.g., for vessel coagulation in liver surgery). Colle et al. used the same circuitry for monopolar subcortical stimulation when connected with the usual stimulator devices.

They have applied this method since 2004 in over 500 patients during tumor resection with cortical and subcortical stimulation, mostly with awake language and motor monitoring.

A method is presented using existing stimulation and wiring devices by which simultaneous subcortical stimulation and ultrasonic aspiration are applied with the same tool. The accuracy, safety, and speed of intrinsic intracranial lesion resection can be improved when subcortical stimulation is applied
((Colle H, Colle D, Noens B, Dhaen B, Alessi G, Muller P, Aerts A, Robert E, van der Linden C. [[Subcortical Stimulation]] with Tip of [[Ultrasound Aspirator]]. J Neurol Surg A Cent Eur Neurosurg. 2021 Aug 25. doi: 10.1055/s-0039-1691824. Epub ahead of print. PMID: 34433223.)).

===== Videos =====
[[Awake]] [[Brain Mapping]] in [[Dominant Side]] [[Insular Glioma Surgery]]: 2 Dimensional Operative Video
((Hameed NUF, Zhu Y, Qiu T, Wu J. Awake Brain Mapping in Dominant Side Insular
Glioma Surgery: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown). 2018 
Feb 16. doi: 10.1093/ons/opx299. [Epub ahead of print] PubMed PMID: 29471530.
)).