The Procedure of Intraoperative Neuropsychological Assessment in the Excision of Cerebral Tumours Located in Eloquent Areas

This paper discusses in detail the procedure of neuropsychological assessment before, during and after awaked craniotomies carried out for the excision of neoplasms located in the eloquent areas of the brain. In the years 2000-2015 we performed awake craniotomies in 123 patients. The authors present their personal experience in the applicability of the diagnostic tools used for the intra-operative monitoring of selected cognitive and executive functions. The tests assess various aspects of speech, verbal memory, precise movements and streognosis. The inclusion and exclusion criteria for the awake craniotomy were listed along with the tricks of the trade – the possibilities of maintaining the number of intra-operative tests and the practical ways of assessing patients’ cognitive processes. It was found that in 85 (69%) of the patients through the use of direct electrical stimulation (DES), we identified the eloquent areas (both verbal and motor) and subsequently monitored the patient’s condition on the resection of the tumour. Among these cases there were 28 (23%) without a postoperative deficit and 32 (26%) in whom deficits were transient, subsiding within 1 to 3 weeks. Neurological deficits persisting for over 4 weeks were observed in 10 (8%) of these patients. In the group of 38 patients with negative stimulation, there were no new postoperative neurological or neuropsychological deficits. Our experience confirms that awaked craniotomy facilitates the safe resection of tumours located in the eloquent brain allowing one to maximise the excision and minimise the risk of a postoperative deficit.