CASE REPORT
Awake surgery for eloquent area glioma in pregnant patient – case report with 7 years follow up
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1
St. Raphael Hospital, Scanmed, Department of Neurosurgery, Krakow, Poland
2
Childrens’ University Hospital, Department of Pediatric Neurosurgery, Jagiellonian University
Medical College, Krakow, Poland
Submission date: 2024-07-01
Final revision date: 2024-09-10
Acceptance date: 2024-09-10
Publication date: 2025-01-31
Medicine and Public Health 2024;2(1):1-7
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ABSTRACT
Background:
Awake glioma surgery in pregnant patients occurs rarely and is a huge challenge for
the whole therapeutic team, requiring the cooperation of a neurosurgeon, an anaesthetist, a speech therapist and an obstetrician.
In this paper we present the case of a 31-year-old patient in 22 hbd with low grade glioma (LGG) of the left temporal lobe.
The patient was admitted to the outpatient clinic, having experienced transient speech disorders for about a week. An MRI examination revealed an extensive tumour in the left temporal region. The speech cortical centres were mapped using fMRI and the awake surgery was tailored. The surgery was performed under neuroleptanalgesia with dexmedetomidine and remifentanil and regional anaesthesia. The speech centres were located. The tumour was completely removed, revealing astrocytoma fibrillare WHO II. The patient’s speech was continuously monitored, as well as the foetal vital functions. The course of the pregnancy was uneventful. In the 48th month after the first operation, the patient underwent a reoperation due to tumour recurrence with consecutive protonotherapy. Currently, 88 months after the first operation, the patient and child both remain in very good condition
Conclusions:
Few cases of glioma resection with intraoperative awakening in pregnant women have been described in the literature. The awake method seems to be an optimal treatment option.