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Surgical resection of supratentorial cavernous angiomas located in eloquent areas poses a significant risk to the patient of postoperative neurological impairment and justifies intraoperative functional monitoring.

The indication for awake brain surgery depends on a prerequisite, i.e. recognition that the brain area concerned is truly eloquent, and identification of one or more functions that must be preserved. These functions are determined preoperatively in collaboration with the patient, and neuropsychological tests considered to be the most relevant are performed in the operating room according to each team's technical preferences.

The value of FDG-PET remains controversial in the study of brain tumors because of the high FDG uptake in gray matter. The aim of this study was to evaluate the utility of 18FDG-PET delayed acquisitions in the distinction of brain tumors from the cortex. Thirty patients with cerebral tumors were included, 25 high-grade tumors and five low grade. Two FDG-PET acquisitions, early (1h), and delayed (5h), were performed. On the delayed images, two types of three-dimensional regions of interest (ROI) were drawn using a Bayesian segmentation based on a Poisson law, the lesion ROI, specific (LS) and total (LT), and the ROI of references, on the healthy hemicortex (SG) and on the healthy white matter (SB). These ROI were reported on the early images. The evolution of the visualization of the lesions was appreciated using a qualitative visual analysis and a ROI ratios analysis. On the delayed images, the visual and the ROI ratios analysis showed an improvement of the visualization of the hypermetabolic specific lesions compared to the SG and the SB. There was also a contrast improvement between the hypometabolic specific lesions and the SG with the ROI ratios analysis. Conclusion: delayed acquisitions in FDG-PET improve the visualization of brain tumors from the cortex. Dual phase FDG-PET with delayed acquisition could constitute an additional tool in the management of brain tumors.

In an effort to extend the potential relationship between the methylation status of MGMT promoter and response to CENU therapy, we examined the methylation status of MGMT promoter in 44 patients with glioblastomas. Tumor specimens were obtained during surgery before adjuvant treatment, frozen and stored at −80 °C until for DNA extraction process. DNA methylation patterns in the CpG island of the MGMT gene were determined in every tumor by methylation specific PCR (MSP). These results were then related to overall survival and response to alkylating agents using statistical analysis. Methylation of the MGMT promoter was detected in 68% of tumors, and 96.7% of methylated tumors exhibited also an unmethylated status. There was no relationship between the methylation status of the MGMT promoter and overall survival and response to alkylating agents. Our observations do not lead us to consider promoter methylation of MGMT gene as a prognostic factor of responsiveness to alkylating agents in glioblastomas.