The value of cortical stimulation applied to the surgery of malignant gliomas in language areas

This study analyzes the utility of peroperative cortical language mapping a pplied to the surgery of high-grade gliomas situated within or in close vic inity to speech areas. Fifteen consecutive patients harboring high-grade gl iomas located in the dominant hemisphere, causing regressive or minor langu age troubles, underwent awake craniotomy in our institution between June 19 98 and April 2000. The technique of cortical stimulation under local anesth esia for language mapping, initially described by Ojemann and colleagues, w as applied with some modifications. All patients tolerated awake craniotomy except one, who was intubated after the mapping procedure. Mapping results confirmed a high variability in location of language sites. It was possibl e to achieve a gross total tumor removal in all cases. Nine patients (60%) exhibit ed a transient postoperative aggravation Two patients (13%) present ed permanent phasic aggravation. One patient died 16 days after surgery fro m pulmonary embolism. Five patients died for tumor progression, with a mean survival time of 16.4 months and a median high-quality survival period of 14.2 months. With a mean follow-up of 9.9 months (range, 18-6 months), the 9 survivors are recurrence-free and reveal no significant change in linguis tic abilities. This technique is well tolerated and consents to maximize th e extent of surgical removal while minimizing the risks of permanent postop erative deficits. This results in an improvement of survival and quality of life.