Abstract
Extensive surgical removal of brain tumors to achieve an adequate safety margin is usually impossible because such extensive removal carries the risk of additional morbidity. Therefore, debulking of the tumor followed by adjuvant therapy has become the standard treatment for glioma. However, the rate of tumor removal remains the most important factor for the outcome, so as much tumor as possible must be removed without causing morbidity, even if the glioma is located near eloquent areas. Intraoperative functional brain mapping and monitoring, and preoperative functional mapping by magnetoen-cephalography (MEG) are methods for the prevention of morbidity. These techniques can provide important information about tumor localization and the relationship with the surrounding eloquent areas. Of course, excellent surgical technique remains critical for achieving an acceptable outcome in addition to the mapping and monitoring techniques. We have developed a new surgical technique combining sulcotomy and gyrectomy for the treatment of glioma. Glioma usually originates from the subcortex in one gyrus and invades the deep white matter. Therefore, the gyrus harboring the tumor can be separated from the eloquent area in the sulcus at least on the cortical level. We describe this surgical technique as applied to intraaxial lesions.
