SURG-26. AWAKE CRANIOTOMY WITH 5-ALA IN HIGH GRADE GLIOMAS GIVES SIMULTANEOUS GUIDANCE OF TUMOR AND FUNCTIONAL BORDER

Abstract

BACKGROUND: In high-grade gliomas (HGG) the use of 5-ALA as surgical assistance is proven not only to increase the number of patients with gross-total resection (GTR) but also improve overall survival (OS). Not all patients may have the benefit of GTR due to closeness to eloquent areas risking neurological deficits. In low grade gliomas awake mapping craniotomy is becoming standard of care in many centres. In HGG patients this procedure is frequently used but combining these two methods may help the surgeon achieving the best possible resection maintaining the onco-functional balance for the individual patient and maintaining a good outcome. METHODS: 19 patients aged 35 to 70, median age 54 (9 females) was operated for suspected HGG with the combined method of 5-ALA assisted surgery and awake mapping craniotomy with a median surgical time of 148 minutes. Retrospectively the hospital records were reviewed for information on neuropsychological assistance, histological report, postoperative MRI and neurological status. RESULTS: The procedure was the 1st operation for 11 of 19 patients, for 5 patients it was the second operation and for 4 patients it was the 3rd or more procedure. Complete or near complete tumor removal was obtained in 10 of 19 cases and in 12 cases more than 90 % of the tumor volume was resected judged by volume measurements. In cases of first time surgery in GBM 6 (67%) of 9 patients had GTR. CONCLUSION: Despite close relationship with eloquent structures the combined procedure of 5-ALA and awake mapping led us to an overall satisfactory tumor removal without exacerbating the condition postsurgical. Keywords: Brain tumor, surgery, 5-ALA, Awake mapping craniotomy, high grade gliomas.