scholarly journals Surgical Resection of Gliomas in Motor Cortex: Prognostic Analysis in Awake Craniotomy and General Anesthesia Approaches

2018 ◽  
Author(s):  
Paulo de Aguiar ◽  
Bruno Camporeze ◽  
Chiara Caggiano ◽  
Stephanie Bologna ◽  
Cassiano Marchi ◽  
...  
Keyword(s):  
Motor Cortex ◽  
General Anesthesia ◽  
Surgical Resection ◽  
Awake Craniotomy ◽  
Prognostic Analysis

Comparison of Motor Outcome in Patients Undergoing Awake vs General Anesthesia Surgery for Brain Tumors Located Within or Adjacent to the Motor Pathways

Neurosurgery ◽  
2019 ◽  
Vol 85 (3) ◽  
pp. E470-E476 ◽  
Author(s):  
Roni Zelitzki ◽  
Akiva Korn ◽  
Eti Arial ◽  
Carmit Ben-Harosh ◽  
Zvi Ram ◽  
...  
Keyword(s):  
Motor Cortex ◽  
Brain Tumors ◽  
General Anesthesia ◽  
Tumor Resection ◽  
Residual Tumor ◽  
Extent Of Resection ◽  
Awake Craniotomy ◽  
Motor Deficits ◽  
Surgical Removal ◽  
Motor Outcome

Abstract BACKGROUND Surgical removal of intra-axial brain tumors aims at maximal tumor resection while preserving function. The potential benefit of awake craniotomy over craniotomy under general anesthesia (GA) for motor preservation is yet unknown. OBJECTIVE To compare the clinical outcomes of patients who underwent surgery for perirolandic tumors while either awake or under GA. METHODS Between 2004 and 2015, 1126 patients underwent surgical resection of newly diagnosed intra-axial tumors in a single institution. Data from 85 patients (44 awake, 41 GA) with full dataset who underwent resections for perirolandic tumors were retrospectively analyzed. RESULTS Identification of the motor cortex required significantly higher stimulation thresholds in anesthetized patients (9.1 ± 4 vs 6.2 ± 2.7 mA for awake patients, P = .0008). There was no group difference in the subcortical threshold for motor response used to assess the proximity of the lesion to the corticospinal (pyramidal) tract. High-grade gliomas were the most commonly treated pathology. The extent of resection and residual tumor volume were not different between groups. Postoperative motor deficits were more common in the anesthetized patients at 1 wk (P = .046), but no difference between the groups was detected at 3 mo. Patients in the GA group had a longer mean length of hospitalization (10.3 vs 6.7 d for the awake group, P = .003). CONCLUSION Awake craniotomy results in a better early postoperative motor outcome and shorter hospitalization compared with patients who underwent the same surgery under GA. The finding of higher cortical thresholds for the identification of the motor cortex in anesthetized patients may suggest an inhibitory effect of anesthetic agents on motor function.

Continuous Intraoperative Neurophysiological Monitoring of the Motor Pathways Using Depth Electrodes During Surgical Resection of an Epileptogenic Lesion: A Novel Technique

2021 ◽  
Author(s):  
Denise F Chen ◽  
Jon T Willie ◽  
David Cabrera ◽  
Katie L Bullinger ◽  
Ioannis Karakis
Keyword(s):  
Motor Cortex ◽  
Surgical Resection ◽  
Radiation Necrosis ◽  
World Health ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Epileptogenic Zone ◽  
Motor Pathways ◽  
Depth Electrodes ◽  
Epileptogenic Lesion

Abstract BACKGROUND AND IMPORTANCE Intraoperative neurophysiological monitoring of the motor pathways during epilepsy surgery is essential to safely achieve maximal resection of the epileptogenic zone. Motor evoked potential (MEP) recording is usually performed intermittently during resection using a handheld stimulator or continuously through an electrode array placed on the motor cortex. We present a novel variation of continuous MEP acquisition through previously implanted depth electrodes in the perirolandic cortex. CLINICAL PRESENTATION A 60-yr-old woman with a history of a left frontal meningioma (World Health Organization [WHO] grade II) treated with surgical resection and radiation presented with residual right hemiparesis and refractory epilepsy. Imaging demonstrated a perirolandic lesion with surrounding edema and mass effect in the prior surgical site, suspicious for radiation necrosis versus tumor recurrence. Presurgical electrocorticography (ECoG) with orthogonal, stereotactically implanted depth electrodes (stereoelectroencephalography [SEEG]) of the perirolandic cortex captured seizure onsets from the supplementary motor area (SMA) and primary motor cortex (PMC). The patient underwent a left frontal craniotomy for repeat resection and tissue diagnosis. Intraoperative ECoG and MEPs were obtained continuously with direct cortical stimulation through the indwelling SEEG electrodes in the PMC. Maximal resection was achieved with preservation of direct cortical MEPs and without deterioration of her baseline hemiparesis. Biopsy revealed radiation necrosis. At 30-mo follow-up, the patient had only rare seizures (Engel class IIB). CONCLUSION Intraoperative cortical MEP acquisition through implanted SEEG electrode arrays is a potentially safe and effective alternative approach to continuously monitor the motor pathways during the resection of a perirolandic epileptogenic lesion, without the need for surgical interruptions.

Anesthetic Management of Awake Craniotomy for Resection of the Language and Motor Cortex Vascular Malformations

2020 ◽  
Vol 143 ◽  
pp. e136-e148
Author(s):  
Annie Ting Wang ◽  
Promod Pillai ◽  
Elyse Guran ◽  
Harmony Carter ◽  
Tanya Minasian ◽  
...  
Keyword(s):  
Motor Cortex ◽  
Vascular Malformations ◽  
Anesthetic Management ◽  
Awake Craniotomy

Awake Craniotomy vs Craniotomy Under General Anesthesia for Perirolandic Gliomas: Evaluating Perioperative Complications and Extent of Resection

Neurosurgery ◽  
2017 ◽  
Vol 81 (3) ◽  
pp. 481-489 ◽  
Author(s):  
Chikezie I. Eseonu ◽  
Jordina Rincon-Torroella ◽  
Karim ReFaey ◽  
Young M. Lee ◽  
Jasvinder Nangiana ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Perioperative Complications ◽  
Extent Of Resection ◽  
Awake Craniotomy

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

Prognostic Analysis of Surgical Resection for Pulmonary Metastasis from Hepatocellular Carcinoma

2016 ◽  
Vol 40 (9) ◽  
pp. 2178-2185 ◽  
Author(s):  
Yusuke Takahashi ◽  
◽  
Norihiko Ikeda ◽  
Jun Nakajima ◽  
Noriyoshi Sawabata ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Surgical Resection ◽  
Pulmonary Metastasis ◽  
Prognostic Analysis

scholarly journals Surgical Resection of Non-Glial Tumors in the Motor Cortex

2016 ◽  
Vol 4 (2) ◽  
pp. 70 ◽  
Author(s):  
Seong-Jong Lee ◽  
Sun-Chul Hwang ◽  
Soo Bin Im ◽  
Bum-Tae Kim
Keyword(s):  
Motor Cortex ◽  
Surgical Resection ◽  
Glial Tumors

scholarly journals Comparison of conscious sedation and general anesthesia for motor mapping and resection of tumors located near motor cortex

2003 ◽  
Vol 15 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Todd W. Vitaz ◽  
William Marx ◽  
Jonathan D. Victor ◽  
Philip H. Gutin
Keyword(s):  
Motor Cortex ◽  
General Anesthesia ◽  
Conscious Sedation ◽  
Neurological Deficits ◽  
Anesthetic Technique ◽  
Neurophysiological Monitoring ◽  
Motor Mapping ◽  
Eloquent Cortex ◽  
Group 2 ◽  
Group 1

Object The surgical treatment of tumors located near eloquent cortex carries a high risk of inducing worsening neurological deficits. Intraoperative electrocorticography techniques have been developed to help identify these areas at the time of surgery in an effort to minimize such risks. The optimal anesthetic technique for conducting these procedures, however, has never been determined. Methods The authors conducted a retrospective study to compare patients who underwent intraoperative motor mapping between September 2000 and May 2002. Demographic and neurophysiological monitoring data were collected from the hospital records. Patients were divided into two groups based on the anesthetic technique used for surgery: in Group 1 general anesthesia was used, and in Group 2 conscious sedation. Group 1 comprised 24 patients (mean age 47 years) with 16 right- and eight left-sided lesions. Group 2 consisted of 21 patients (mean age 46 years) with 18 right- and three left-sided lesions. Pathological diagnoses were similar between the two groups. Motor stimulation was elicited in 12 patients (50%) in Group 1 and in 21 patients (100%) in Group 2 (p < 0.001). In addition, the mean stimulation amplitude required was significantly higher (13 mA) in patients in whom conscious sedation was used as opposed to general anesthesia (5 mA, p < 0.0001). Electrographic evidence of seizures was seen in 29% of Group 1 cmpared with 10% of Group 2 patients (p > 0.05). Conclusions The use of conscious sedation as an anesthetic technique for motor mapping not only improves the chances of achieving successful stimulation and identification of motor cortex in relationship to the lesion, but it also allows for repetitive monitoring of the patient's motor function during resection of the lesion.

Pre- and Intraoperative Mapping for Tumors in the Primary Motor Cortex: Decision-Making Process in Surgical Resection

2020 ◽  
Author(s):  
José Pedro Lavrador ◽  
Prajwal Ghimire ◽  
Christian Brogna ◽  
Luciano Furlanetti ◽  
Sabina Patel ◽  
...  
Keyword(s):  
Decision Making ◽  
Motor Cortex ◽  
Surgical Resection ◽  
Process Model ◽  
Primary Motor Cortex ◽  
Treatment Plan ◽  
Motor Deficit ◽  
Decision Making Process ◽  
Total Resection ◽  
Intraoperative Mapping

Abstract Background Lesions within the primary motor cortex (M1) and the corticospinal tract (CST) represent a significant surgical challenge with a delicate functional trade-off that should be integrated in the overall patient-centered treatment plan. Methods Patients with lesions within the M1 and CST with preoperative cortical and subcortical mapping (navigated transcranial magnetic stimulation [nTMS] and tractography), intraoperative mapping, and intraoperative provisional histologic information (smear with and without 5-aminolevulinic acid [5-ALA]) were included. This independently acquired information was integrated in a decision-making process model to determine the intraoperative extent of resection. Results A total of 10 patients (6 patients with metastatic precentral tumor; 1 patient with grade III and 2 patients with grade IV gliomas; 1 patient with precentral cavernoma) were included in the study. Most of the patients (60%) had a preoperative motor deficit. The nTMS documented M1 invasion in all cases, and in eight patients, the lesions were embedded within the CST. Overall, 70% of patients underwent gross total resection; 20% of patients underwent near-total resection of the lesions. In only one patient was no surgical resection possible after both preoperative and intraoperative mapping. Overall, 70% of patients remained stable postoperatively, and previous motor weakness improved in 20%. Conclusion The independently acquired anatomical (anatomical MRI) and functional (nTMS and tractography) tests in patients with CST lesions provide a useful guide for resection. The inclusion of histologic information (smear with or without 5-ALA) further allows the surgical team to balance the potential functional risks within the global treatment plan. Therefore, the patient is kept at the center of the informed decision-making process.

Sign in / Sign up

Export Citation Format

Share Document