Awake Craniotomy for Left Insular Low-Grade Glioma Removal on a Patient with Learning Disabilities
01 March 2016
20 April 2016
10 February 2017 (online)
Introduction Low-grade gliomas (LGG) are slow-growing primary brain tumors in adults, with high tropism for eloquent areas. Standard approach in treatment of LGG is awake craniotomy with intraoperative cortical mapping — a method which is usually used on adult and fully cooperative patients.
Case Report We present the case of a patient with learning disabilities (PLD) who was operated for left insular LGG awake craniotomy, and intraoperative cortical mapping were performed and the tumor was gross totally removed.
Conclusion Awake surgery for left insular LGG removal is challenging; however, it can be performed safely and successfully on PLD.
- 1 Capelle L, Fontaine D, Mandonnet E. , et al; French Réseau d'Étude des Gliomes. Spontaneous and therapeutic prognostic factors in adult hemispheric World Health Organization Grade II gliomas: a series of 1097 cases: clinical article. J Neurosurg 2013; 118 (06) 1157-1168
- 2 Jakola AS, Myrmel KS, Kloster R. , et al. Comparison of a strategy favoring early surgical resection vs a strategy favoring watchful waiting in low-grade gliomas. JAMA 2012; 308 (18) 1881-1888
- 3 Duffau H. A new philosophy in surgery for diffuse low-grade glioma (DLGG): oncological and functional outcomes. Neurochirurgie 2013; 59 (01) 2-8
- 4 Hervey-Jumper SL, Li J, Lau D. , et al. Awake craniotomy to maximize glioma resection: methods and technical nuances over a 27-year period. J Neurosurg 2015; 123 (02) 325-339
- 5 Ogren K, Sjöström S, Bengtsson NO. The unknown history of lobotomy: women, children and idiots were lobotomized [in Swedish]. Lakartidningen 2000; 97 (30–31): 3395-3398
- 6 Balogun JA, Khan OH, Taylor M. , et al. Pediatric awake craniotomy and intra-operative stimulation mapping. J Clin Neurosci 2014; 21 (11) 1891-1894
- 7 Marks L, Adler N, Blom-Reukers H, Elhorst JH, Kraaijenhagen-Oostinga A, Vanobbergen J. Ethics on the dental treatment of patients with mental disability: results of a Netherlands - Belgium survey. J Forensic Odontostomatol 2012; 30 (Suppl. 01) 21-28
- 8 Erickson KM, Cole DJ. Anesthetic considerations for awake craniotomy for epilepsy and functional neurosurgery. Anesthesiol Clin 2012; 30 (02) 241-268
- 9 Conte V, Baratta P, Tomaselli P, Songa V, Magni L, Stocchetti N. Awake neurosurgery: an update. Minerva Anestesiol 2008; 74 (06) 289-292
- 10 Ponnudurai RN, Clarke-Moore A, Ekulide I. , et al. A prospective study of bispectral index scoring in mentally retarded patients receiving general anesthesia. J Clin Anesth 2010; 22 (06) 432-436
- 11 Shields WD. Management of epilepsy in mentally retarded children using the newer antiepileptic drugs, vagus nerve stimulation, and surgery. J Child Neurol 2004; 19 (Suppl. 01) S58-S64