• Barbagallo Giuseppe M V GMV Department of Neurological Surgery, Policlinico "G. Rodolico" University Hospital, Catania, Italy; Interdisciplinary Research Center on Brain , Antonio Morrone, and Francesco Certo.
• Department of Neurological Surgery, Policlinico "G. Rodolico" University Hospital, Catania, Italy; Interdisciplinary Research Center on Brain Tumor Diagnosis and Treatment, University of Catania, Catania, Italy. Electronic address: gbarbagallo@unict.it.
• World Neurosurg. 2018 Nov 1; 119: e159-e166.

BackgroundAwake surgery is an effective technique to improve safety in surgical resection of lesions involving eloquent areas of the brain. Intraoperative 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 ResultsFour 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 low-grade 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. Intraoperative 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.Conclusionsi-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.Copyright © 2018. Published by Elsevier Inc.

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