{"id":"674bd195-0175-4270-84b6-371a104799d1","slug":"next-door-intraoperative-magnetic-resonance-imaging-for-awake-craniotomy-preliminary-experience-and-technical-note","title":"“Next Door” intraoperative magnetic resonance imaging for awake craniotomy: Preliminary experience and technical note","authors":["Roger Neves Mathias","Paulo Henrique Pires de Aguiar","Evandro Pinto da Luz Oliveira","Silvia Mazzali Verst","Vinícius Vieira","Marcos Fernando Docema","Marcos Vinícius Calfat Maldaun"],"abstract":"Background: During glioma surgery “maximal safe resection” must be the main goal. Intraoperative magnetic resonance imaging (iMRI) associated with awake craniotomy (AC) is a valuable tool to achieve this objective. In this article, AC with a “next-door” iMRI concept is described in a stepwise protocol. Methods: This is a retrospective analysis of 18 patients submitted to AC using iMRI; a stepwise protocol is also discussed. Results: The mean age was 41.7 years. Hemiparesis, aphasia, and seizures were the main initial symptoms of the patients. Sixty-six percent of the tumors were located in the left hemisphere. All tumors were near or within eloquent areas. Fifty-three percent of the cases were glioblastomas multiforme and 47% of the patients had low grade gliomas. The mean surgical time and iMRI time were 4 h 4 min and 30 min, respectively. New resection was performed in 33% after iMRI. Extent of resection (EOR) higher than 95% was possible in 66.7% of the patients. The main reason of EOR lower than 95% was positive mapping of eloquent areas (6 patients). Eighty percent of the patients experienced improvement of their deficits immediately after the surgery or had a stable clinical status whereas 20% had neurological deterioration, however, all of them improved after 30 days. Conclusion: AC associated with “next-door” iMRI is a complex procedure, but if performed using a meticulous technique, it may improve the overall tumor resection and safety of the patients.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/674bd195-0175-4270-84b6-371a104799d1/featured/hero-1782420903067.png","publishDate":"2016-12-12T00:00:00.000Z","doi":"10.4103/2152-7806.195587","categories":["Neuro-oncology","Technical Note"],"fullTextUrl":"http://surgicalneurologyint.com/wp-content/uploads/2016/12/8209/SNI-7-1021.pdf"}