Cortical Mapping Under Local Anesthesia For Tumor Resection

ABSTRACT

-Cortical mapping during tumor resection is a technique that has enjoyed resurgence in the last decade as a useful surgical adjunct. The necessity for this technique stems from the well-appreciated discordance between perceived physiologically eloquent cortex and standard neuroanatomic landmarks in those patients who harbor an intracranial neoplasm. Cortical mapping gives the neurosurgical oncologist who philosophically believes in the value of cytoreductive surgery the ability to resect tumors in both a safe and aggressive manner.

We recently reviewed 248 patients who underwent craniotomy under local anesthesia with cortical mapping to assess the effectiveness of our technique. Over 70% of these patients harbored a glioma of varying grades and histological phenotypes. Minor intraoperative problems of pain, agitation, and hypertension were effectively addressed as our technique and experience progressed over the last 10 years. We were able to achieve a gross total resection in 57% of the cases, most of which were considered inoperable by the referring neurosurgeon. There was an acceptable neurological morbidity of 4% and mortality rate of under 1%.

KEYWORD

Cortical mapping - tumor resection - eloquent cortex