Both intravenous and inhalational agents are known to affect these EP mapping techniques. Intraoperative mapping of the cortex with stimulating and recording electrodes is termed as electrophysiological (EP) mapping.The EP mapping of motor, sensory and language cortex is widely employed in the resection of lesions involving or adjacent to the eloquent areas. However, proper identification of the above mentioned areas would enable the surgeon to radically remove the tumours. If the lesions are adjacent to the above mentioned areas, the normal anatomy would get distorted. If the lesions are within these regions surgeons could either take a biopsy or do a intracapsular decompression without damaging the mentioned areas to avoid postoperative dysfunction.
In patients presenting for surgical resection of lesions involving, or adjacent to, the functionally important eloquent cortical areas, it is vital to achieve complete or near complete resection of the pathology without damaging the healthy surrounding tissues.The eloquent areas that the surgeons are concerned with are the primary motor, premotor cortex, supplementary motor cortex and speech areas. Good quality evidence is lacking and hence there is a need for well-designed RCTs to determine the effects of anaesthetic agents on electrophysiological mapping in this specific surgical population. Even though the diagnostic is obtained after imagistic head investigation for other reasons than a tumour. The authors of this review aimed to identify and evaluate randomised controlled trials (RCTS) assessing the effect of anaesthetic agents on electrophysiological mapping of these functional areas of the brain. usually are within non-eloquent brain areas. Anaesthetic agents are known to affect the mapping techniques. This technique is called electrophysiological mapping. Electrical properties of the brain cells are often monitored during these surgical procedures to accurately identify the functional areas.
In patients with surgically removable lesions involving, or adjacent to, these areas, it is important to achieve a near complete resection without damaging the functional areas (normal brain tissue). Awake surgery with intraoperative functional mapping is a safe approach to maximize the extent of tumor removal and to minimize the resultant neurological deficits in the treatment of glioma involving the eloquent cortex.There are discrete areas in the brain that are responsible for sensation (sensory), control of movement (motor) and language functions. However, surgical resection of gliomas located within the sensorimotor or language areas remains a neurosurgical challenge in reducing eloquent neurological sequelae. Identifying and subsequently avoiding these areas during a neurosurgery is crucial for improving recovery and postoperative quality of life. The most common areas of eloquent cortex are in the left temporal and frontal lobes for speech and language, bilateral occipital lobes for vision, bilateral parietal lobes for. The occipital lobe is the back part of the brain that is involved with vision. The eloquent cortex consists of regions in the brain that are responsible for lan-guage comprehension, speech, and motor function. Eloquent cortex is a name used by neurologists for areas of cortex thatif removedwill result in loss of sensory processing or linguistic ability, or paralysis. Extensive radical resection of gliomas prolongs the overall survival and improves the patient’s quality of life. The parietal lobe houses Wernicke’s area, which helps the brain understand spoken language. Four patients had improved Karnofsky performance status (KPS) scores after surgery, 17 patients were stable, and no patient had lower KPS score.
Postoperative findings included no change in symptoms and signs in 10 patients, improvement of the preoperative deficit in 11 patients. Gross total removal was performed in 18 patients.
ELOQUENT AREAS OF BRAIN SERIES
Awake surgery was performed in a series of 21 patients with gliomas in eloquent areas with the use of intraoperative electrical mapping.
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