Fundamentals of Brain Tumor Surgery in Eloquent Areas

Central nervous system tumors are a major cause of morbidity and mortality. Themain pathology involved is brain metastases, followed by intrinsic gliomas. In nearly all cases, surgery is the initial and most important measure to change natural course of disease. In brain metastases and meningiomas, gross total resection is also precluded, and usually more achievable, because of biological behavior of tumor and extrinsic presentation. Generally these tumors push or compress eloquent areas, but spare them. In intrinsic tumors, complete resection is often difficult, once tumor is invasive and may even be within eloquent cortex. When tumors occur in eloquent areas such as sensorial, motor and language cortex, there is the need for taking several measures to avoid worsening of symptoms after surgery. Especially in lesions involving language cortex, an awake craniotomy may be performed to assess intraoperatively language functions.