PIONEER

Intraoperative mapping techniques

Glioma surgery is a balance between “maximum surgery” (removing as much from the tumor as possible) and “safe surgery” (preventing functional loss or neurological complications). Intraoperative mapping techniques help neurosurgeons to differentiate between healthy brain tissue and tumor tissue during the operation. Operations with these techniques are often performed when tumors are located close to brain regions that are responsible for important functions, such as the movement of arms or legs, speech production, or language understanding. Damage to these brain regions due to the surgery can lead to neurological complications (“deficits”) after surgery. Examples of these deficits are weakness in an arm or leg or problems with speech production. The use of intraoperative mapping techniques might make the operation safer and allow neurosurgeons to remove more of the tumor during the operation.

Testing (which is called “mapping”) the function of arm or leg can be carried out while the patient is awake or asleep. Testing speech function can only be carried out while the patient is awake, while testing motor function (the movement of arms or legs) can be carried out both while the patient is awake or asleep. If the patient is awake, this is also commonly called “awake craniotomy”.

The first aim of our research is to investigate if these techniques can improve the outcomes for glioma patients. For example: amount of tumor removed, short-term and long-term neurological complications, overall functioning, quality of life, cognitive functioning, language functioning, and survival. We also study if we can predict before surgery if a patient would likely benefit from the use of these techniques during surgery.

The second aim of our research is to investigate the current differences in daily practice of these techniques. For example, the indications for these techniques, the specific settings, and the decision making of the surgeon before, during, and after the operation. The goal is to compare different ways of applying these techniques and to investigate how we can optimize them further.

Awake Brain Surgery at the Erasmus Medical Center, Rotterdam

Awake Brain Surgery at the University of California, San Francisco

Related publications

Chronologically

Rammeloo E, Young JS, Schouten JW, Bos EM, Hervey-Jumper SL, Jungk C, Krieg SM, Smith T, Rincon-Torroella J, Bettegowda C, Maruyama T, Wagner A, Schucht P, Broekman MLD, De Vleeschouwer S, Nahed BV, Berger MS, Vincent AJPE, Gerritsen JKW. Preoperative assessment of tumor eloquence and resectability: an international survey. J Neurooncol. 2025. doi:10.1007/s11060-025-05067-0

Vooijs M, Robertson FC, Blitz SE, Jungk C, Krieg SM, Schucht P, De Vleeschouwer S, Vincent AJPE, Berger MS, Nahed BV, Broekman MLD, Gerritsen JKW. Level I and II deficits – A clinical survey on international practice of awake craniotomy and definitions of postoperative “major” and “minor” deficits. Neurooncol Adv. 2024. doi: 10.1093/noajnl/vdae206

Van Opijnen M, Sadigh Y, Dijkstra ME, Young JS, Krieg SM, Ille S, Sanai N, Rincon-Torroella J, Maruyama T, Schucht P, Smith TR, Nahed BV, Broekman MLD, De Vleeschouwer S, Berger MS, Vincent AJPE, Gerritsen JKW. The impact of intraoperative mapping during re-resection in recurrent gliomas: a systematic review. J Neurooncol. 2025. 171:485-93

Gerritsen JKW, Mekary RA, Pisica D, Zwarthoed RH, Kilgallon JL, Nawabi NL, Jessurun CAC, Versyck G, Moussa A, Bouhaddou H, Pruijn KP, Fisher FL, Larivière E, Solie L, Kloet A, Nandoe Tewarie R, Schouten JW, Bos EM, Dirven CMF, van den Bent MJ, Chang SM, Smith TR, Broekman MLD, Vincent AJPE, De Vleeschouwer S. Onco-functional outcome after resection for eloquent glioblastoma (OFO): A propensity-score matched analysis of an international, multicentre, cohort study. Eur J Cancer. 2024. doi:10.106/j.ejca.2024.114311

Rammeloo E, Schouten JW, Krikour K, Bos EM, Berger MS, Nahed BV, Vincent AJPE, Gerritsen JKW. Preoperative assessment of eloquence in neurosurgery: a systematic review. J Neurooncol. 2023. 165:413-30

Gerritsen JKW, Zwarthoed RH, Kilgallon JL, Nawabi NL, Versyck G, Jessurun CAC, Pruijn KP, Fisher FL, Lariviere E, Solie L, Mekary RA, Satoer DD, Schouten JW, Bos EM, Kloet A, Nandoe Tewarie R, Smith TR, Dirven CMF, De Vleeschouwer S, Vincent AJPE, Broekman MLD. Impact of maximal extent of resection on postoperative deficits, patient functioning, and survival within clinically important glioblastoma subgroups. Neuro Oncol. 2023. 25:958-72.

Gerritsen JKW, Zwarthoed RH, Kilgallon JL, Nawabi NL, Versyck G, Jessurun CAC, Pruijn KP, Fisher FL, Lariviere E, Solie L, Mekary RA, Satoer DD, Schouten JW, Bos EM, Kloet A, Nandoe Tewarie R, Smith TR, Dirven CMF, De Vleeschouwer S, Broekman MLD, Vincent AJPE. Effect of awake craniotomy in glioblastoma in eloquent areas (GLIOMAP): a propensity score-matched analysis of an international, multicentre, cohort study. Lancet Oncol. 2022. 23:802-17.

Gerritsen JKW, Broekman MLD, De Vleeschouwer S, Schucht P, Jungk C, Krieg M, Nahed BV, Berger M, Vincent AJPE. Decision making and surgical modality selection in glioblastoma patients: an international multicenter survey. J Neurooncol. 2022. 156:465-82

Gerritsen JKW, Broekman MLD, De Vleeschouwer S, Schucht P, Jungk C, Krieg M, Nahed BV, Berger M, Vincent AJPE. Global comparison of awake and asleep mapping procedures in glioma surgery: An international multicenter survey. Neurooncol Pract. 2022. 9:123-32.

Gerritsen JKW, Broekman MLD, De Vleeschouwer S, Schucht P, Nahed BV, Berger MS, Vincent AJPE. Safe surgery for glioblastoma: recent advances and modern challenges. Neurooncol Pract. 2022. 9:364-79.

Gerritsen JKW, Arends L, Klimek M, Dirven CMF, Vincent AJPE. Impact of intraoperative stimulation mapping on high-grade glioma surgery outcome: a meta-analysis. Acta Neurochir (Wien). 2019. 161:99-107.

Gerritsen JKW, Viëtor CL, Rizopoulos D, Schouten JW, Klimek M, Dirven CMF, Vincent AJPE. Awake craniotomy versus craniotomy under general anesthesia without surgery adjuncts for supratentorial glioblastoma in eloquent areas: a retrospective matched case-control study. Acta Neurochir (Wien). 2019. 161:307-15.