• Roger Neves Mathias, Paulo Henrique Pires de Aguiar, Evandro Pinto da Luz Oliveira, Silvia Mazzali Verst, Vinícius Vieira, Marcos Fernando Docema, and Calfat MaldaunMarcos ViníciusMVNeurosurgery Division, State University of Campinas, Unicamp, Sírio-Libranês, Brazil; Neurosurgery Division, Sírio-Libranês Hospital, Sírio-Libranês, Brazil; Neurosurgery Division, Santa Paula Hospital, Santa Paula, USA..
• Neurosurgery Division, State University of Campinas, Unicamp, Sírio-Libranês, Brazil; Neurosurgery Division, Sírio-Libranês Hospital, Sírio-Libranês, Brazil.
• Surg Neurol Int. 2016 Jan 1; 7 (Suppl 40): S1021-S1027.

BackgroundDuring glioma surgery "maximal safe resection" must be the main goal. Intraoperative magnetic resonance imaging (iMRI) associated with awake craniotomy (AC) is a valuable tool to achieve this objective. In this article, AC with a "next-door" iMRI concept is described in a stepwise protocol.MethodsThis is a retrospective analysis of 18 patients submitted to AC using iMRI; a stepwise protocol is also discussed.ResultsThe mean age was 41.7 years. Hemiparesis, aphasia, and seizures were the main initial symptoms of the patients. Sixty-six percent of the tumors were located in the left hemisphere. All tumors were near or within eloquent areas. Fifty-three percent of the cases were glioblastomas multiforme and 47% of the patients had low grade gliomas. The mean surgical time and iMRI time were 4 h 4 min and 30 min, respectively. New resection was performed in 33% after iMRI. Extent of resection (EOR) higher than 95% was possible in 66.7% of the patients. The main reason of EOR lower than 95% was positive mapping of eloquent areas (6 patients). Eighty percent of the patients experienced improvement of their deficits immediately after the surgery or had a stable clinical status whereas 20% had neurological deterioration, however, all of them improved after 30 days.ConclusionAC associated with "next-door" iMRI is a complex procedure, but if performed using a meticulous technique, it may improve the overall tumor resection and safety of the patients.

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