M Wager1, P Rigoard2, C Bouyer3, V Baudiffier3, V Stal4, B Bataille5, R Gil6, F Du Boisgueheneuc3. 1. Department of Neurosurgery, Poitiers University Hospital, INSERM, U1084, 2, rue de La Miletrie, BP 577, 86021 Poitiers Cedex, France. Electronic address: m.wager@chu-poitiers.fr. 2. Department of Neurosurgery, Poitiers University Hospital, INSERM, U1084, 2, rue de La Miletrie, BP 577, 86021 Poitiers Cedex, France; Spine and Neuromodulation Functional Unit, Poitiers University, 86021 Poitiers, France; Neuromodulation and Neural Networks Laboratory (N3lab.), 86021 Poitiers, France. 3. Department of Neurology, Neuropsychology and Speech Therapy Unit, CM2R, Poitiers University Hospital, 86021 Poitiers, France. 4. Department of Clinical Neurophysiology, Poitiers University Hospital, 86021 Poitiers, France. 5. Department of Neurosurgery, Poitiers University Hospital, INSERM, U1084, 2, rue de La Miletrie, BP 577, 86021 Poitiers Cedex, France. 6. Poitiers University School of Medicine, 86021 Poitiers, France.
Abstract
INTRODUCTION: The indication for awake brain surgery depends on a prerequisite, i.e. recognition that the brain area concerned is truly eloquent, and identification of one or more functions that must be preserved. These functions are determined preoperatively in collaboration with the patient, and neuropsychological tests considered to be the most relevant are performed in the operating room according to each team's technical preferences. OPERATING ENVIRONMENT: The neurosurgeon must choose transfer equipment considered to be relevant. Although a minimal technological environment is an option, a surgical team with great human wealth is essential, composed of specialized personnel with complementary skills. CHOICE AND IMPLEMENTATION OF INTRAOPERATIVE TESTS: The choice of intraoperative tests, which can be relatively simple for certain primary functions, can be much more difficult for high-level cognitive functions. No consensus has been reached concerning these tests, which must therefore be selected on an individual basis. Intraoperative testing must be based on preoperative multidisciplinary decisions made jointly by the neurosurgeon, neurologist, speech therapist and neuropsychologist. CONCLUSIONS: Numerous operating tools and technology transfers are available for neurosurgical teams performing awake brain surgery but none - or very few - of them constitutes a mandatory prerequisite. In contrast, the transition from the concept of eloquent brain area to that of brain functions that must be preserved requires highly skilled multidisciplinary human resources. This goal will be more likely achieved in centers highly specialized in functional oncological neurosurgery.
INTRODUCTION: The indication for awake brain surgery depends on a prerequisite, i.e. recognition that the brain area concerned is truly eloquent, and identification of one or more functions that must be preserved. These functions are determined preoperatively in collaboration with the patient, and neuropsychological tests considered to be the most relevant are performed in the operating room according to each team's technical preferences. OPERATING ENVIRONMENT: The neurosurgeon must choose transfer equipment considered to be relevant. Although a minimal technological environment is an option, a surgical team with great human wealth is essential, composed of specialized personnel with complementary skills. CHOICE AND IMPLEMENTATION OF INTRAOPERATIVE TESTS: The choice of intraoperative tests, which can be relatively simple for certain primary functions, can be much more difficult for high-level cognitive functions. No consensus has been reached concerning these tests, which must therefore be selected on an individual basis. Intraoperative testing must be based on preoperative multidisciplinary decisions made jointly by the neurosurgeon, neurologist, speech therapist and neuropsychologist. CONCLUSIONS: Numerous operating tools and technology transfers are available for neurosurgical teams performing awake brain surgery but none - or very few - of them constitutes a mandatory prerequisite. In contrast, the transition from the concept of eloquent brain area to that of brain functions that must be preserved requires highly skilled multidisciplinary human resources. This goal will be more likely achieved in centers highly specialized in functional oncological neurosurgery.
Authors: Philippe Rigoard; Amine Ounajim; Lisa Goudman; Chantal Wood; Manuel Roulaud; Philippe Page; Bertille Lorgeoux; Sandrine Baron; Kevin Nivole; Mathilde Many; Emmanuel Cuny; Jimmy Voirin; Denys Fontaine; Sylvie Raoul; Patrick Mertens; Philippe Peruzzi; François Caire; Nadia Buisset; Romain David; Maarten Moens; Maxime Billot Journal: J Clin Med Date: 2022-09-22 Impact factor: 4.964