Int{'e}r{^e}t de la stimulation {'e}lectrique directe dans la chirurgie des gliomes en zones fonctionnelles

Glioma surgery in functional areas has undergone a dra- matic development these last few years, thanks to im- provements in both intraoperative functional imaging and direct electrical stimulation of cortical areas or asso- ciation pathways. The goal of these techniques to achieve complete as possible surgical removal of tumors located in eloquent areas (sensitive, motor and language areas) with minimal risk of permanent sequelae. To be reliable, a rigorous methodology is required. Current cortical mapping is very easy to achieve, whereas mapping of as- sociation pathways will require much more experience. In case of tumors located in somatosensorial or language areas, the difficulties related to accurate sub cortical lo- calization are combined with these of local anesthesia and the best task choice to evaluate the integrity of cogni- tive functions. These functional techniques allow total or sub total removal in 52% to 76.2% of patients. Transient worsening is observed in 13% to 80% of the patients; the rate of permanent sequelae averages 4%.