Functional approach to brain tumor surgery: awake setting

Surgery for gliomas has three main aims (1) obtaining material for histological and molecular diagnosis, (2) achieve cytoreduction in order to improve oncological outcome, and (3) provide symptoms relief. Due to the infiltrative nature of gliomas, malignant cells can be found also outside tumor margins, making the approaches based solely on imaging quite limited. The change of the paradigm of this approach is based on guiding resection according to function instead of tailoring removal on preoperative images. In the following chapter, we will briefly describe the rationale of functional neurosurgery, the preoperative multidisciplinary evaluation of patients needed to perform the surgery along with the intraoperative procedure used to safely and efficiently applying the concept of functional neurosurgery. At the end, we will also analyze the results of the technique particularly in term of functional outcome.