Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Jul-Sep;10(3):139-44.
doi: 10.4103/1793-5482.161189.

The role of awake craniotomy in reducing intraoperative visual field deficits during tumor surgery

Racheal Wolfson  1 , Neil Soni  1 , Ashish H Shah  1 , Khadil Hosein  1 , Ananth Sastry  1 , Amade Bregy  1 , Ricardo J Komotar  1
Affiliations

The role of awake craniotomy in reducing intraoperative visual field deficits during tumor surgery

Racheal Wolfson et al. Asian J Neurosurg. 2015 Jul-Sep.

Abstract

Objective: Homonymous hemianopia due to damage to the optic radiations or visual cortex is a possible consequence of tumor resection involving the temporal or occipital lobes. The purpose of this review is to present and analyze a series of studies regarding the use of awake craniotomy (AC) to decrease visual field deficits following neurosurgery.

Materials and methods: A literature search was performed using the Medline and PubMed databases from 1970 and 2014 that compared various uses of AC other than intraoperative motor/somatosensory/language mapping with a focus on visual field mapping.

Results: For the 17 patients analyzed in this study, 14 surgeries resulted in quadrantanopia, 1 in hemianopia, and 2 without visual deficits. Overall, patient satisfaction with AC was high, and AC was a means to reduce surgery-related complications and cost related with the procedure.

Conclusion: AC is a safe and tolerable procedure that can be used effectively to map optic radiations and the visual cortices in order to preserve visual function during resection of tumors infiltrating the temporal and occipital lobes. In the majority of cases, a homonymous hemianopia was prevented and patients were left with a quadrantanopia that did not interfere with daily function.

Keywords: Awake craniotomy; novel uses; review.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Visual evoked potential. The patient focuses on the target in the center while the checkerboard pattern alternates the black and white squares every half-second. Evoked potentials are recorded using electrodes placed on the scalp
Figure 2
Figure 2
Humphrey visual field test. The target viewed by the patient on the computer screen (a), and the target with a light flash in the peripheral field (b)
Figure 3
Figure 3
Results of a Humphrey visual field test. Shaded areas are locations of visual field deficit[22]
Figure 4
Figure 4
Results of a Goldmann perimetry test. The shading indicates the area of visual deficit[23]
Figure 5
Figure 5
Postoperative results graph
See this image and copyright information in PMC

References

    1. Serletis D, Bernstein M. Prospective study of awake craniotomy used routinely and nonselectively for supratentorial tumors. J Neurosurg. 2007;107:1–6. - PubMed
    1. Khu KJ, Doglietto F, Radovanovic I, Taleb F, Mendelsohn D, Zadeh G, et al. Patients’ perceptions of awake and outpatient craniotomy for brain tumor: A qualitative study. J Neurosurg. 2010;112:1056–60. - PubMed
    1. Bonhomme V, Franssen C, Hans P. Awake craniotomy. Eur J Anaesthesiol. 2009;26:906–12. - PubMed
    1. Kim SS, McCutcheon IE, Suki D, Weinberg JS, Sawaya R, Lang FF, et al. Awake craniotomy for brain tumors near eloquent cortex: Correlation of intraoperative cortical mapping with neurological outcomes in 309 consecutive patients. Neurosurgery. 2009;64:836–45. - PubMed
    1. Brydges G, Atkinson R, Perry MJ, Hurst D, Laqua T, Wiemers J. Awake craniotomy: A practice overview. AANA J. 2012;80:61–8. - PubMed