Current issues in awake surgery

Awake surgery is an important methodology, which can increase the indications of tumor removal in the eloquent area, to identify the structures crucial for brain functions, especially in language both at the cortical and subcortical areas, to optimize the extent of resection. To achieve maximum resection, a functional brain mapping technique can increase the percentage of patients in which total and subtotal resection is achieved and decreases the percentage of post-operative neurological deficit. In this paper, we selected several current issues in awake surgery such as: 1) What is the indication for the motor cortex, 2) Do we still need the Wada test, 3) How to select tasks for functional mapping and monitoring, 4) The negative mapping technique, 5) Management of a pseudo-positive result, and 6) Making the final decision to remove functional area.