Awake Craniotomy with Cortical and Subcortical Speech Mapping for Supramarginal Cavernoma Resection

2020 ◽  
Vol 141 ◽  
pp. 260
Author(s):  
Ricardo A. Domingo ◽  
Tito Vivas-Buitrago ◽  
David S. Sabsevitz ◽  
Erik H. Middlebrooks ◽  
Alfredo Quinones-Hinojosa
Keyword(s):  
Awake Craniotomy ◽  
Speech Mapping

Awake craniotomy for gliomas in a high-field intraoperative magnetic resonance imaging suite: analysis of 42 cases

2014 ◽  
Vol 121 (4) ◽  
pp. 810-817 ◽  
Author(s):  
Marcos V. C. Maldaun ◽  
Shumaila N. Khawja ◽  
Nicholas B. Levine ◽  
Ganesh Rao ◽  
Frederick F. Lang ◽  
...  
Keyword(s):  
High Field ◽  
Tumor Resection ◽  
Patient Positioning ◽  
Extent Of Resection ◽  
Awake Craniotomy ◽  
Neurological Deficits ◽  
Speech Mapping ◽  
Duration Of Surgery ◽  
The Mean ◽  
Subcortical Mapping

Object The object of this study was to describe the experience of combining awake craniotomy techniques with high-field (1.5 T) intraoperative MRI (iMRI) for tumors adjacent to eloquent cortex. Methods From a prospective database the authors obtained and evaluated the records of all patients who had undergone awake craniotomy procedures with cortical and subcortical mapping in the iMRI suite. The integration of these two modalities was assessed with respect to safety, operative times, workflow, extent of resection (EOR), and neurological outcome. Results Between February 2010 and December 2011, 42 awake craniotomy procedures using iMRI were performed in 41 patients for the removal of intraaxial tumors. There were 31 left-sided and 11 right-sided tumors. In half of the cases (21 [50%] of 42), the patient was kept awake for both motor and speech mapping. The mean duration of surgery overall was 7.3 hours (range 4.0–13.9 hours). The median EOR overall was 90%, and gross-total resection (EOR ≥ 95%) was achieved in 17 cases (40.5%). After viewing the first MR images after initial resection, further resection was performed in 17 cases (40.5%); the mean EOR in these cases increased from 56% to 67% after further resection. No deficits were observed preoperatively in 33 cases (78.5%), and worsening neurological deficits were noted immediately after surgery in 11 cases (26.2%). At 1 month after surgery, however, worsened neurological function was observed in only 1 case (2.3%). Conclusions There was a learning curve with regard to patient positioning and setup times, although it did not adversely affect patient outcomes. Awake craniotomy can be safely performed in a high-field (1.5 T) iMRI suite to maximize tumor resection in eloquent brain areas with an acceptable morbidity profile at 1 month.

scholarly journals Awake craniotomy for glioblastoma in COVID-19–positive patients and delivering the standard of care: illustrative case

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Reinier Alvarez ◽  
Rupesh Kotecha ◽  
Michael W. McDermott ◽  
Vitaly Siomin
Keyword(s):  
Standard Of Care ◽  
Awake Craniotomy ◽  
Illustrative Case ◽  
Speech Mapping ◽  
Viral Particles ◽  
Positive Treatment ◽  
Frontal Operculum ◽  
Eloquent Cortex ◽  
Poor Outcomes ◽  
Novel Coronavirus

BACKGROUND Providing the standard of care to patients with glioblastoma (GBM) during the novel coronavirus of 2019 (COVID-19) pandemic is a challenge, particularly if a patient tests positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Further difficulties occur in eloquent cortex tumors because awake speech mapping can theoretically aerosolize viral particles and expose staff. Moreover, microscopic neurosurgery has become difficult because the use of airborne-level personal protective equipment (PPE) crowds the space between the surgeon and the eyepiece. However, delivering substandard care will inevitably lead to disease progression and poor outcomes. OBSERVATIONS A 60-year-old man with a left insular and frontal operculum GBM was found to be COVID-19 positive. Treatment was postponed pending a negative SARS-CoV-2 result, but in the interim, he developed intratumoral hemorrhage with progressive expressive aphasia. Because the tumor was causing dominant hemisphere language symptomatology, an awake craniotomy was the recommended surgical approach. With the use of airborne-level PPE and a surgical drape to protect the surgeon from the direction of potential aerosolization, near-total gross resection was achieved. LESSONS Delaying the treatment of patients with GBM who test positive for COVID-19 will lead to further neurological deterioration. Optimal and timely treatment such as awake speech mapping for COVID-19–positive patients with GBM can be provided safely.

scholarly journals High resolution passive speech mapping in dominant hemisphere glioma surgery

2019 ◽  
Vol 21 (3) ◽  
pp. 37-43 ◽  
Author(s):  
M. V. Sinkin ◽  
A. E. Osadchiy ◽  
M. A. Lebedev ◽  
K. V. Volkova ◽  
M. S. Kondratova ◽  
...  
Keyword(s):  
High Resolution ◽  
Gamma Oscillations ◽  
Awake Craniotomy ◽  
Cortical Mapping ◽  
Broca’S Area ◽  
Broca's Area ◽  
Study Objective ◽  
Speech Mapping ◽  
Number Of Patients ◽  
Eloquent Area

Background. Intraoperative brain mapping is one of the most critical stages of neurosurgical intervention in the eloquent area of the cerebral cortex. Traditionally direct cortical electrical stimulation is used for these purposes, but it can lead to seizures and loss of consciousness that makes it impossible to continue the procedure. Moreover, it significantly changes the surgery plan, especially in case of speech mapping during awake craniotomy.The study objective is to create a setup for intraoperative eloquent cortical areas passive mapping, and to compare informativity and safety of passive and active speech mapping.Materials and methods. We have created and tested a mobile device for high-resolution mapping of the Broca’s area that uses the analysis of the desynchronization processes in high-gamma oscillations in 64 micro-contact grid electrode for electrocorticography during awake craniotomy when patient pronounces the objects and actions.Results. We found precise coincidence for localization of the Broca’s area, determined by analyzing of bioelectric signal obtained from the electrocorticography and cortical mapping performed by bipolar direct cortical stimulation using Penfield method.Conclusion. The passive cortical speech mapping expands the potentialities of neurosurgical operations in the eloquent area of the brain and can increase the number of patients for whom this study is achievable. Further studies needed to evolve algorithms and sets of stimuli to expand the list of functional zones that can be mapped passively.

Awake Craniotomy–An Anesthesiologist Point of View

2015 ◽  
Vol 76 (S 02) ◽  
Author(s):  
Inga Batinica ◽  
K. Rotim ◽  
T. Sajko ◽  
M. Schonwald ◽  
S. Salkičević
Keyword(s):  
Point Of View ◽  
Awake Craniotomy

TRANSIENT FACIAL NERVE PALSY AFTER SCALP BLOCK FOR AWAKE CRANIOTOMY: A CASE REPORT

2018 ◽  
Vol 4 (5) ◽  
pp. 369-371
Author(s):  
Rajashree U Gandhe . ◽  
Chinmaya P Bhave . ◽  
Avinash S Kakde . ◽  
Neha T Gedam .
Keyword(s):  
Case Report ◽  
Facial Nerve ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Awake Craniotomy ◽  
Scalp Block

scholarly journals A Novel Language Paradigm for Intraoperative Language Mapping: Feasibility and Evaluation

2021 ◽  
Vol 10 (4) ◽  
pp. 655
Author(s):  
Katharina Rosengarth ◽  
Delin Pai ◽  
Frank Dodoo-Schittko ◽  
Katharina Hense ◽  
Teele Tamm ◽  
...  
Keyword(s):  
Healthy Subjects ◽  
Intraoperative Complications ◽  
Evaluation Study ◽  
Awake Craniotomy ◽  
Language Mapping ◽  
Tumor Patients ◽  
Language Functions ◽  
Before And After ◽  
Assessment Time ◽  
Neuropsychological Outcomes

(1) Background—Mapping language using direct cortical stimulation (DCS) during an awake craniotomy is difficult without using more than one language paradigm that particularly follows the demand of DCS by not exceeding the assessment time of 4 s to prevent intraoperative complications. We designed an intraoperative language paradigm by combining classical picture naming and verb generation, which safely engaged highly relevant language functions. (2) Methods—An evaluation study investigated whether a single trial of the language task could be performed in less than 4 s in 30 healthy subjects and whether the suggested language paradigm sufficiently pictured the cortical language network using functional magnetic resonance imaging (fMRI) in 12 healthy subjects. In a feasibility study, 24 brain tumor patients conducted the language task during an awake craniotomy. The patients’ neuropsychological outcomes were monitored before and after surgery. (3) Results—The fMRI results in healthy subjects showed activations in a language-associated network around the (left) sylvian fissure. Single language trials could be performed within 4 s. Intraoperatively, all tumor patients showed DCS-induced language errors while conducting the novel language task. Postoperatively, mild neuropsychological impairments appeared compared to the presurgical assessment. (4) Conclusions—These data support the use of a novel language paradigm that safely monitors highly relevant language functions intraoperatively, which can consequently minimize negative postoperative neuropsychological outcomes.

scholarly journals MS-1 Surgical strategy for brain tumor based on molecular and functional connectomics profiles

2020 ◽  
Vol 2 (Supplement_3) ◽  
pp. ii2-ii2
Author(s):  
Tatsuya Abe
Keyword(s):  
Overall Survival ◽  
Brain Tumor ◽  
Standard Procedure ◽  
Awake Craniotomy ◽  
Surgical Strategy ◽  
Neurological Deficits ◽  
Cortical Mapping ◽  
Photodynamic Diagnosis ◽  
Tumor Surgery ◽  
Brain Tumor Surgery

Abstract It is reported that the development of new perioperative motor deficits was associated with decreased overall survival despite similar extent of resection and adjuvant therapy. The maximum safe resection without any neurological deficits is required to improve overall survival in patients with brain tumor. Surgery is performed with various modalities, such as neuro-monitoring, photodynamic diagnosis, neuro-navigation, awake craniotomy, intraoperative MRI, and so on. Above all, awake craniotomy technique is now the standard procedure to achieve the maximum safe resection in patients with brain tumor. It is well known that before any treatment, gliomas generate globally (and not only focally) altered functional connectomics profiles, with various patterns of neural reorganization allowing different levels of cognitive compensation. Therefore, perioperative cortical mapping and elucidation of functional network, neuroplasticity and reorganization are important for brain tumor surgery. On the other hand, recent studies have proposed several gene signatures as biomarkers for different grades of gliomas from various perspectives. Then, we aimed to identify these biomarkers in pre-operative and/or intra-operative periods, using liquid biopsy, immunostaining and various PCR methods including rapid genotyping assay. In this presentation, we would like to demonstrate our surgical strategy based on molecular and functional connectomics profiles.

Challenges in Starting an Awake Craniotomy Project in a Low-Resource Public Health System

2021 ◽  
Vol 146 ◽  
pp. 277-279
Author(s):  
Lucas Alverne F. Albuquerque ◽  
Gabryella S. Diógenes ◽  
Fátima C. Pessoa
Keyword(s):  
Public Health ◽  
Health System ◽  
Public Health System ◽  
Awake Craniotomy ◽  
Low Resource
Sign in / Sign up

Export Citation Format

Share Document