“Awake” Resection of Glioma in Semisitting –  a Case Report

Authors: R. Bartoš 1;  D. Bejšovec 2;  A. Malucelli 1;  J. Prokšová 3;  J. Lodin 1;  Š. Čapek 4;  M. Sameš 1
Authors‘ workplace: Neurochirurgická klinika UJEP a Krajská zdravotní a. s., Masarykova nemocnice v Ústí nad Labem, o. z. 1;  KAPIM – Anesteziologická klinika UJEP a Krajská zdravotní a. s., Masarykova nemocnice v Ústí nad Labem, o. z. 2;  Rehabilitační oddělení, Logopedie, Krajská zdravotní a. s., Masarykova nemocnice v Ústí nad Labem, o. z. 3;  Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA 4
Published in: Cesk Slov Neurol N 2017; 80/113(2): 220-223
Category: Case Report
doi: 10.14735/amcsnn2017220


Lateral or supine positions are the traditional positions for cranial tumor resections performed with an “awake” component. These positions are used effectively for patients with tumors adjacent to speech centers or located in the superior frontal or precentral gyrus respectively. However, these may be unsatisfactory for tumors in a close proximity to the parieto-occipital region. In this case report, we describe “awake” surgery performed on a patient in semisitting position.

Case description:
A 57-year-old patient suffered second recurrence of a glioblastoma multiforme tumor with subcortical invasion of the postcentral gyrus. Due to a high risk of severe neurological deficit, it was decided to perform an awake surgery with the semisitting position providing the best exposure to the lesion and the pyramidal tract. The pyramidal tract of the patient was mapped using motor responses to regular stimuli during which the surgeon recected the tumor. The patient was fully cooperative throughout the procedure and subjectively described the semisitting position as comfortable. Postoperatively, the patient showed no signs of new neurological deficits. Planned re-radiation therapy was not performed.

This clinical case demonstrates successful use of the semisitting position in “awake” surgery and we recommend considering its use for tumors in previously challenging locations, such as the lower parietal lobules or postcentral gyrus. This position could also be used during surgeries involving visual pathways mapping.

Key words:
semisitting position – „awake“ surgery – glioma – parietal lobe – pyramidal tract – cortical stimulation mapping

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Chinese summary - 摘要

“醒”半神经胶质瘤切除术 - 病例报告


侧卧位或仰卧位是用“清醒”部件进行颅骨切除术的传统位置。这些位置有效地用于与言语中心相邻的肿瘤患者,或分别位于上额叶或前中回。然而,对于靠近枕骨 - 枕骨区域的肿瘤,这些可能是不令人满意的。在这个案例报告中,我们描述了在半坐姿中对患者进行的“清醒”手术。






半坐位 - “清醒”手术 - 胶质瘤 - 顶叶 - 锥体束 - 皮质刺激图


1. Hervey-Jumper SL, Li J, Lau D, et al. Awake craniotomy to maximize glioma resection: methods and technical nuances over a 27-year period. J Neurosurg 2015;123(2):325– 39. doi: 10.3171/ 2014.10.JNS141520.

2. Kim S, McCutcheon IE, Suki D, et al. Awake craniotomy for brain tumors near eloquent cortex: cor­relation of intraoperative cortical mapp­ing with neuroogical outcomes in 309 consecutive patients. Neurosurgery 2009;64(5):836– 46. doi: 10.1227/ 01.NEU.0000342405. 80881.81.

3. Gras-Combe G, Moriz-Gas­ser S, Herbet G, et al. Intraoperative subcortical electrical mapp­ing of optic radiations in awake surgery for glioma involv­ing visual pathways. J Neurosurg 2012;117(3):466– 73. doi: 10.3171/ 2012.6.JNS111981.

4. Šteňo A, Karlík M, Mendel P, et al. Navigated threedimensional intraoperative ultrasound-guided awake resection of low-grade glioma partial­ly infiltrat­ing optic radiation. Acta Neurochir 2012;154(7):1255– 62. doi: 10.1007/ s00701-012-1357-6.

5. Maldonado IL, Moritz-Gas­ser S, Menjot de Champfleur N, et al. Surgery for gliomas involv­ing the left inferior parietal lobule: new insights into the functional anatomy provided by stimulation mapp­ing in awake patients. J Neurosurg 2011;115(4):770– 9. doi: 10.3171/ 2011.5.JNS112.

Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 2

2017 Issue 2

Most read in this issue
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account