Figure 3

Preoperative MR and Met-PET images as well as postoperative MR images of remaining five patients in SupTR group. (A–C) A 47-year-old woman with seizure suffering from contrast-enhanced (CE) tumor in the left superior frontal gyrus (SFG) (A). The methionine uptake was observed in larger area than CE, extending anteriorly along the SFG (B). Both of CE and methionine area were removed under awake mapping. (D–F) A 56-year-old woman with dysesthesia in her left upper arm harboring small CE tumor in the right ventral postcentral gyrus (PostCG) (D). The Met accumulation was found in not only CE area but also surrounding subcortical white matter area (E). Supratotal resection (SupTR) of CE and Met uptake were achieved with awake craniotomy (F). (G–I) A CE tumor with subcortical low intensity area on MR images were demonstrated in a 42-year-old man (G). Note that Met uptake extend beyond the CE border into the subcortical area (H). SupTR of CE and Met uptake were accomplished with awake cortical and subcortical mapping (I). (J–L) A 59-year-old man with GBM in his left SFG (J). Met accumulation was multifocal in SFG, PostCG (K), and angular gyrus (not shown). All of CE lesion and Met uptake area were removed under awake surgery (L). (M–O) A 76-year-old woman with small CE lesion was found in her PostCG (M). Interestingly, Met uptake was observed in much larger area than CE lesion (N). SupTR, both of CE and Met uptake were obtained with awake craniotomy (O).