The neurosurgery department of the Toulouse University Hospital is the second in France to have developed awake surgery to operate on brain tumors. The technique makes it possible to preserve certain functions in patients and to advance research in the knowledge of the organ.
Used in France since 1997, the technique of waking surgery to operate on brain tumors continues to evolve. The neurosurgery department of Pr Franck-Emmanuel Roux, at the Toulouse-Purpan University Hospital, a pioneer in this field, contributes greatly to this. Its latest publication, in the prestigious scientific journal Journal of Neurosurgery (1), should make it possible to better define the number of electrostimulations necessary to properly identify where brain functions are located. In this case, Professor Roux’s team worked on the language area, located in the left hemisphere of the brain but whose contours vary from one individual to another.
The data collected are all advances in knowledge of the organ. They are also a step closer to better care for patients with brain tumors, such as glioblastoma (2,700 new cases per year in France) that cannot be cured but for which extraction by surgery allows to gain several months or years on the disease. The Toulouse team (surgeons, anesthetists, CerCo researchers (2)) has operated on nearly 600 patients since 1997.
“Awake surgery makes it possible to operate brain tumors with greater security, with the objective of preserving essential brain functions: motor, sensory, language, writing, arithmetic and orientation functions in particular. Thanks to it, we can help more patients. To identify these functions, we send a small electric current. The patient does not feel it – there is no sensory fiber in the brain -, it interacts during the intervention “, explains Franck-Emmanuel Roux.
Improve brain mapping
In the Journal of Neurosurgery, emphasis is placed on the importance of the preoperative assessment in surgeries concerning the language area (study on 200 patients operated on between 2007 and 2017). “This is done by a speech therapist, Emilie Réhault. We observed that, when this pre-operative assessment shows that the patient already has small disorders, it is necessary to carry out more electrostimulations to properly assess his language. Until now, the number of stimulations was fixed by a publication of the 1970s. Our work shows that it is necessary to adapt this number according to the patient’s condition: the worse the language balance, the more we will have to stimulate ” , underlines the neurosurgeon.
To further improve brain mapping, work is currently underway to specify the areas related to spatial representation. “Awake surgery allows us to go further than research conducted through MRI (Magnetic Resonance Imaging), it works on the same principle as a 3D helmet. We are observing that, in patients, the estimation of the distance from an object is delayed when certain points in the parietal zone are stimulated. All of this work contributes to a better understanding of the brain and helps the surgeon in his decision-making and his gesture “, notes Robin Baures, researcher at CerCo.
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