Intraoperative Computed Tomography and Awake Craniotomy: A Useful and Safe Combination in Brain Surgery

BACKGROUND: Awake surgery is an effective technique to improve safety in surgical resection of lesions involving eloquent areas of the brain. lntraoperative imaging guidance and neuronavigation are widely applied in neurosurgical procedures. However, data on the application of intraoperative imaging to awake craniotomies are limited. We report our experience with intraoperative computed tomography (i-CT) during awake surgery, focusing on technical feasibility and effectiveness. METHODS AND RESULTS: Four patients with a lesion located in an eloquent area of the brain-1 with a cavernous hemangioma, 1 with a high-grade glioma, and 2 with a lowgrade glioma (LGG)-underwent awake surgery with neuronavigation guidance. In all patients, i-CT was used to evaluate the completeness of resection or the extent of residual tumor. lntraoperative ultrasound was also used during microsurgery to verify the presence of residual tumor. The use of i-CT us allowed to obtain updated images for neuronavigation and to correct for brain shift. CONCLUSIONS: i-CT in awake surgery is reliable and effective. It does not significantly affect the duration of surgery and does not add stress for the patient. The possibility to correct for brain shift also in awake patients can increase the precision and accuracy of surgery, particularly in cases of LGG, avoiding the resection of normal white matter or tumor remnants in noneloquent areas.