DTI-Based Neuronavigation Guided Eloquent Area Glioma Resection with Awake Craniotomy: Supra-Functional Resection of Eloquent Area Gliomas

AIM: To present an overview of our awake craniotomy practices performed with complementary use of diffusion tensor imaging (DTI)-based neuronavigation (DTI-bN) and cortical-subcortical electrical stimulation for glioma resection located in eloquent areas, and the clinical outcomes of these practices regarding neurological morbidity and residual tumour volume. MATERIAL and METHODS: This study was conducted between October 2016 and December 2017 involving 18 cases. The DTI-bN method, in addition to cortical-subcortical stimulation, was done with awake craniotomy. Changes in the neurological status of the patients and results of the method regarding residual tumour volume were recorded. This retrospective study use data obtained from patients' records and radiological examinations. RESULTS: Of the 18 patients, a gross total resection was performed on nine patients (50%), a near total resection was performed on seven patients (38.8%) and a subtotal resection was performed on two patients (11.1%). Intraoperative neurological deterioration was observed in 14 of 18 patients during their surgical procedures, and neurological examinations in the sixth post-operative month revealed permanent deficits in two patients. CONCLUSION: This study is one of the rare series to have presented the results of the use DTI-bN method as well as cortical-subcortical stimulation during awake craniotomy, according to literature review. In 88% of cases, tumour resection rates are over 90%.