Awake craniotomy for removal of gliomas in eloquent areas: an analysis of 21 cases

2022 ◽  
Author(s):  
Xi Chen ◽  
Jinli Sun ◽  
Weichao Jiang ◽  
Zhi Zhu ◽  
Sifang Chen ◽  
...  
Keyword(s):  
Awake Craniotomy ◽  
Eloquent Areas

scholarly journals Anesthetic considerations for awake craniotomy

2020 ◽  
Vol 15 (3) ◽  
pp. 269-274
Author(s):  
Seung Hyun Kim ◽  
Seung Ho Choi
Keyword(s):  
Brain Mapping ◽  
Gold Standard ◽  
Anesthetic Management ◽  
Standard Of Care ◽  
Awake Craniotomy ◽  
Anesthesia Care ◽  
Surgical Team ◽  
Monitored Anesthesia Care ◽  
Eloquent Areas ◽  
Anesthetic Considerations

Awake craniotomy is a gold standard of care for resection of brain tumors located within or close to the eloquent areas. Both asleep-awake-asleep technique and monitored anesthesia care have been used effectively for awake craniotomy and the choice of optimal anesthetic approach is primarily based on the preferences of the anesthesiologist and surgical team. Propofol, remifentanil, dexmedetomidine, and scalp nerve block provide the reliable conditions for intraoperative brain mapping. Appropriate patient selection, adequate perioperative psychological support, and proper anesthetic management for individual patients in each stage of surgery are crucial for procedural safety, success, and patient satisfaction.

Awake craniotomy versus craniotomy under general anesthesia without surgery adjuncts for supratentorial glioblastoma in eloquent areas: a retrospective matched case-control study

2019 ◽  
Vol 161 (2) ◽  
pp. 307-315 ◽  
Author(s):  
Jasper Kees Wim Gerritsen ◽  
Charlotte Lauren Viëtor ◽  
Dimitris Rizopoulos ◽  
Joost Willem Schouten ◽  
Markus Klimek ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Case Control Study ◽  
Case Control ◽  
Awake Craniotomy ◽  
Eloquent Areas ◽  
Matched Case ◽  
Matched Case Control Study ◽  
Control Study

scholarly journals Awake Craniotomy for Left Insular Low-Grade Glioma Removal on a Patient with Learning Disabilities

2017 ◽  
Vol 06 (01) ◽  
pp. 041-043 ◽  
Author(s):  
Andrej Vranic ◽  
Blaz Koritnik ◽  
Jasmina Markovic-Bozic
Keyword(s):  
Learning Disabilities ◽  
Case Report ◽  
Brain Tumors ◽  
Awake Craniotomy ◽  
Awake Surgery ◽  
Cortical Mapping ◽  
Low Grade ◽  
Low Grade Gliomas ◽  
Eloquent Areas ◽  
Slow Growing

Introduction Low-grade gliomas (LGG) are slow-growing primary brain tumors in adults, with high tropism for eloquent areas. Standard approach in treatment of LGG is awake craniotomy with intraoperative cortical mapping — a method which is usually used on adult and fully cooperative patients. Case Report We present the case of a patient with learning disabilities (PLD) who was operated for left insular LGG awake craniotomy, and intraoperative cortical mapping were performed and the tumor was gross totally removed. Conclusion Awake surgery for left insular LGG removal is challenging; however, it can be performed safely and successfully on PLD.

Awake Craniotomy vs Surgery Under General Anesthesia for Resection of Supratentorial Lesions4

Neurosurgery ◽  
2011 ◽  
Vol 68 (5) ◽  
pp. 1192-1199 ◽  
Author(s):  
Oumar Sacko ◽  
Valérie Lauwers-Cances ◽  
David Brauge ◽  
Musa Sesay ◽  
Adam Brenner ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Brain Mapping ◽  
Neurological Outcome ◽  
Neurological Complication ◽  
Awake Craniotomy ◽  
Neurological Deficits ◽  
Complication Rates ◽  
Eloquent Areas ◽  
Duration Of Surgery

Abstract BACKGROUND: The use of an awake craniotomy in the treatment of supratentorial lesions is a challenge for both patients and staff in the operation theater. OBJECT: To assess the safety and effectiveness of an awake craniotomy with brain mapping in comparison with a craniotomy performed under general anesthesia. METHODS: We prospectively compared 2 groups of patients who underwent surgery for supratentorial lesions: those in whom an awake craniotomy with intraoperative brain mapping was used (AC group, n = 214) and those in whom surgery was performed under general anesthesia (GA group, n = 361, including 72 patients with lesions in eloquent areas). The AC group included lesions in close proximity to the eloquent cortex that were surgically treated on an elective basis. RESULTS: Globally, the 2 groups were comparable in terms of sex, age, American Society of Anesthesiologists score, pathology, size of lesions, quality of resection, duration of surgery, and neurological outcome, and different in tumor location and preoperative neurological deficits (higher in the AC group). However, specific data analysis of patients with lesions in eloquent areas revealed a significantly better neurological outcome and quality of resection (P < .001) in the AC group than the subgroup of GA patients with lesions in eloquent areas. Surgery was uneventful in AC patients and they were discharged home sooner. CONCLUSION: AC with brain mapping is safe and allows maximal removal of lesions close to functional areas with low neurological complication rates. It provides an excellent alternative to craniotomy under GA.

Surgical benefits of combined awake craniotomy and intraoperative magnetic resonance imaging for gliomas associated with eloquent areas

2017 ◽  
Vol 127 (4) ◽  
pp. 790-797 ◽  
Author(s):  
Kazuya Motomura ◽  
Atsushi Natsume ◽  
Kentaro Iijima ◽  
Shunichiro Kuramitsu ◽  
Masazumi Fujii ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Tumor Resection ◽  
Residual Tumor ◽  
Awake Craniotomy ◽  
The Other ◽  
Intraoperative Mri ◽  
Awake Surgery ◽  
Eloquent Areas ◽  
Mri Studies ◽  
The Brain

OBJECTIVEMaximum extent of resection (EOR) for lower-grade and high-grade gliomas can increase survival rates of patients. However, these infiltrative gliomas are often observed near or within eloquent regions of the brain. Awake surgery is of known benefit for the treatment of gliomas associated with eloquent regions in that brain function can be preserved. On the other hand, intraoperative MRI (iMRI) has been successfully used to maximize the resection of tumors, which can detect small amounts of residual tumors. Therefore, the authors assessed the value of combining awake craniotomy and iMRI for the resection of brain tumors in eloquent areas of the brain.METHODSThe authors retrospectively reviewed the records of 33 consecutive patients with glial tumors in the eloquent brain areas who underwent awake surgery using iMRI. Volumetric analysis of MRI studies was performed. The pre-, intra-, and postoperative tumor volumes were measured in all cases using MRI studies obtained before, during, and after tumor resection.RESULTSIntraoperative MRI was performed to check for the presence of residual tumor during awake surgery in a total of 25 patients. Initial iMRI confirmed no further tumor resection in 9 patients (36%) because all observable tumors had already been removed. In contrast, intraoperative confirmation of residual tumor during awake surgery led to further tumor resection in 16 cases (64%) and eventually an EOR of more than 90% in 8 of 16 cases (50%). Furthermore, EOR benefiting from iMRI by more than 15% was found in 7 of 16 cases (43.8%). Interestingly, the increase in EOR as a result of iMRI for tumors associated mainly with the insular lobe was significantly greater, at 15.1%, than it was for the other tumors, which was 8.0% (p = 0.001).CONCLUSIONSThis study revealed that combining awake surgery with iMRI was associated with a favorable surgical outcome for intrinsic brain tumors associated with eloquent areas. In particular, these benefits were noted for patients with tumors with complex anatomy, such as those associated with the insular lobe.

scholarly journals Impact on Awake Mapping on Overall Survival and Extent of Resection in Patients With Adult Diffuse Gliomas Within or Near Eloquent Areas: A Retrospective Propensity Score-matched Analysis of Awake Craniotomy Vs. General Anesthesia

2021 ◽  
Author(s):  
Atsushi Fukui ◽  
Yoshihiro Muragaki ◽  
Taiichi Saito ◽  
Masayuki Nitta ◽  
Shunsuke Tsuzuki ◽  
...  
Keyword(s):  
Overall Survival ◽  
Propensity Score ◽  
General Anesthesia ◽  
Propensity Score Matching ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Extent Of Resection ◽  
Awake Craniotomy ◽  
World Health ◽  
Eloquent Areas

Abstract Introduction: Awake craniotomy (AC) with intraoperative mapping is the best approach to preserve neurological function for glioma surgery in eloquent or near eloquent areas, but whether AC improves the extent of resection (EOR) is controversial. Furthermore, there is less evidence of improved overall survival (OS) in glioma patients. This study aimed to compare the long-term clinical outcomes of glioma resection under AC with those under general anesthesia (GA).Methods: Data of 335 patients who underwent surgery with intraoperative magnetic resonance imaging for newly diagnosed gliomas of World Health Organization (WHO) grades II-IV between 2000 and 2013 were reviewed. EOR and OS were quantitatively compared between the AC and GA groups after 1:1 propensity score matching. The two groups were matched for age, preoperative Karnofsky performance status, tumor location, and pathology based on the WHO 2007 classification.Results: After propensity score matching, 91 pairs were obtained. The median EOR were 96.1% (interquartile range [IQR] 7.3) and 97.4% (IQR 14.4) in the AC and GA groups, respectively (p=0.31). The median survival times were 163.3 months (95% confidence interval [CI] 77.9-248.7) and 143.5 months (95% CI 94.4-192.7) in the AC and GA groups, respectively (p=0.585).Conclusions: Even if the glioma was within or close to the eloquent area, AC was comparable with GA in terms of EOR and OS. In case of difficulties in randomizing patients with eloquent or near eloquent glioma, our propensity score-matched analysis provides retrospective evidence that AC can obtain EOR and OS equivalent to removing glioma under GA.

scholarly journals Usefulness of Awake Craniotomy for Low-grade Gliomas in Eloquent Areas

2017 ◽  
Vol 51 (2) ◽  
pp. 74-78
Author(s):  
Hemant Bhagat ◽  
Dibya J Mahakul ◽  
Ashish Aggarwal ◽  
Amey R Savardekar ◽  
Chirag K Ahuja ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Neurological Function ◽  
Awake Craniotomy ◽  
Low Grade ◽  
Tumor Excision ◽  
Low Grade Gliomas ◽  
Eloquent Areas ◽  
Patient Cooperation ◽  
Novel Method

ABSTRACT The biggest dilemma in a neurosurgeon's mind while operating upon low-grade gliomas in eloquent areas is—how to achieve maximal tumor excision while preserving the neurological function. This aim is difficult to achieve once patient is under general anesthesia and hence, patient cooperation cannot be sought to know the neurological function. A novel method to overcome this hurdle is to excise gliomas (especially in eloquent areas) in awake stage while constantly seeking patient cooperation to know the corresponding neurological function. In this study, we operated 10 patients in awake stage and achieved reasonable tumor excision with no added deficits at 3 months follow-up. Hence, this technique achieves a compromise between oncological principle of maximal tumor excision while simultaneously following the neurosurgical principle of no new added deficits. How to cite this article Mahakul DJ, Aggarwal A, Savardekar AR, Bhagat H, Ahuja CK, Gupta SK. Usefulness of Awake Craniotomy for Low-grade Gliomas in Eloquent Areas. J Postgrad Med Edu Res 2017;51(2):74-78.

scholarly journals Surgical resection of low-grade gliomas in eloquent areas with the guidance of the preoperative functional magnetic resonance imaging and craniometric points

2016 ◽  
Vol 7 (04) ◽  
pp. 571-576 ◽  
Author(s):  
Ahmed Abdullah ◽  
Hisham El Shitany ◽  
Waleed Abbass ◽  
Amr Safwat ◽  
Amr K Elsamman ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Functional Magnetic Resonance Imaging ◽  
Surgical Resection ◽  
Awake Craniotomy ◽  
Low Grade ◽  
Functional Magnetic Resonance ◽  
Resonance Imaging ◽  
Low Grade Gliomas ◽  
Eloquent Areas

ABSTRACT Objectives: Surgical resection of low-grade gliomas (LGGs) in eloquent areas is one of the challenges in neurosurgery, using assistant tools to facilitate effective excision with minimal postoperative neurological deficits has been previously discussed (awake craniotomy and intraoperative cortical stimulation); however, these tools could have their own limitations thus implementation of a simple and effective technique that can guide to safe excision is needed in many situations. Materials and Methods: The authors conducted a retrospective analysis of a prospectively collected data of 76 consecutive surgical cases of LGGs of these 21 cases were situated in eloquent areas. Preoperative functional magnetic resonance imaging (fMRI), pre- and post-operative MRI with volumetric analysis of the tumor size was conducted, and intraoperative determination of the craniometric points related to the tumor (navigation guided in 10 cases) were studied to evaluate the effectiveness of the aforementioned tools in safe excision of the aforementioned tumors. Results: Total-near total excision in 14 (66.67%) subtotal in 6 (28.57%), and biopsy in 1 case (4.57%). In long-term follow–up, only one case experienced persistent dysphasia. Conclusion: In spite of its simplicity, the identification of the safe anatomical landmarks guided by the preoperative fMRI is a useful technique that serves in safe excision of LGGs in eloquent areas. Such technique can replace intraoperative evoked potentials or the awake craniotomy in most of the cases. However, navigation-guided excision might be crucial in deeply seated and large tumors to allow safe and radical excision.

scholarly journals Awake craniotomy in brain tumors - Technique systematization and the state of the art

2021 ◽  
Vol 48 ◽  
Author(s):  
MÁRCIO CARDOSO KRAMBEK ◽  
JOÃO LUIZ VITORINO-ARAÚJO ◽  
RENAN MAXIMILIAN LOVATO ◽  
JOSÉ CARLOS ESTEVES VEIGA
Keyword(s):  
Latin America ◽  
State Of The Art ◽  
Standard Technique ◽  
Direct Costs ◽  
Awake Craniotomy ◽  
Anesthetic Technique ◽  
High Grade ◽  
Brain Areas ◽  
Eloquent Areas ◽  
Anesthesia Technique

ABSTRACT The anesthesia for awake craniotomy (AC) is a consecrated anesthetic technique that has been perfected over the years. Initially used to map epileptic foci, it later became the standard technique for the removal of glial neoplasms in eloquent brain areas. We present an AC anesthesia technique consisting of three primordial times, called awake-asleep-awake, and their respective particularities, as well as delve into the anesthetic medications used. Its use in patients with low and high-grade gliomas was favorable for the resection of tumors within the functional boundaries of patients, with shorter hospital stay and lower direct costs. The present study aims to systematize the technique based on the experience of the largest philanthropic hospital in Latin America and discusses the most relevant aspects that have consolidated this technique as the most appropriate in the surgery of gliomas in eloquent areas.

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