. Awake Craniotomy | ScienceGate

(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.

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Accuracy of landmark scalp blocks performed during asleep-awake-asleep awake craniotomy: a retrospective study

JA Clinical Reports ◽

10.1186/s40981-021-00412-4 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Takehito Sato ◽

Kimitoshi Nishiwaki

Keyword(s):

Retrospective Study ◽

Awake Craniotomy

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

Neuro-Oncology Advances ◽

10.1093/noajnl/vdaa143.008 ◽

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.

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

World Neurosurgery ◽

10.1016/j.wneu.2020.12.006 ◽

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

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Anesthesia for awake craniotomy: An update

Colombian Journal of Anesthesiology ◽

10.1016/j.rcae.2014.07.003 ◽

2015 ◽

Vol 43 ◽

pp. 22-28 ◽

Cited By ~ 2

Author(s):

Jason Chui

Keyword(s):

Awake Craniotomy

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Oncological and functional outcomes of supratotal resection of IDH1 wild-type glioblastoma based on 11C-methionine PET: a retrospective, single-center study

Scientific Reports ◽

10.1038/s41598-021-93986-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Seiichiro Hirono ◽

Ko Ozaki ◽

Masayoshi Kobayashi ◽

Ayaka Hara ◽

Tomohiro Yamaki ◽

...

Keyword(s):

Functional Outcomes ◽

Awake Craniotomy ◽

Rank Test ◽

Wild Type ◽

Log Rank Test ◽

Positron Emission ◽

Single Center Study ◽

Supratotal Resection ◽

Subcortical Mapping

AbstractThe oncological and functional outcomes in glioblastoma (GBM) patients following supratotal resection (SupTR), involving complete resection of contrast-enhancing enhanced (CE) tumors and areas of methionine (Met) uptake on 11C-met positron emission tomography (Met-PET), are unknown. We conducted a retrospective review in newly diagnosed, IDH1 wild-type GBM patients, comparing SupTR with gross total resection (GTR), in which only CE tumor tissue was resected. All patients underwent standard radiotherapy and temozolomide treatment, and were followed for tumor recurrence and overall survival (OS). Among the 30 patients included in this study, 7 underwent SupTR and 23 underwent GTR. Awake craniotomy with cortical and subcortical mapping was more frequently performed in the SupTR group than in the GTR group. During the follow-up period, significantly different patterns of disease progression were observed between groups. Although more than 80% of recurrences were local in the GTR group, all recurrences in the SupTR group were distant. Median OS in the GTR and SupTR groups was 18.5 months (95% confidence interval [CI] 14.2–35.1) and not reached (95% CI 30.5-not estimable), respectively; this difference was statistically significant (p = 0.03 by log-rank test). No postoperative neurocognitive decline was evident in patients who underwent SupTR. Compared to GTR alone, aggressive resection of both CE tumors and areas with Met uptake (SupTR) under awake craniotomy with functional mapping results in a survival benefit associated with better local control and neurocognitive preservation.

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NIMG-19. USING FUNCTIONAL ULTRASOUND (FUS) TO MAP BRAIN FUNCTIONALITY AND TUMOR VASCULATURE WITH MICROMETER-MILLISECOND PRECISION

Neuro-Oncology ◽

10.1093/neuonc/noaa215.632 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii151-ii151

Author(s):

Sadaf Soloukey ◽

Arnaud J P E Vincent ◽

Djaina D Satoer ◽

Frits Mastik ◽

Marion Smits ◽

...

Keyword(s):

Decision Making ◽

High Resolution ◽

Cerebral Blood Volume ◽

Power Doppler ◽

Awake Craniotomy ◽

Frame Rate ◽

Low Grade ◽

Neurosurgical Procedures ◽

Tumor Removal ◽

Functional Areas

Abstract OBJECTIVE In the early 20th century, Dr. Cushing first demonstrated the use of electrical stimulation mapping (ESM) to define motor and sensory cortices during neurosurgical procedures. Essentially, little has changed in what guides a neurosurgeon’s intra-operative decision-making since. Inherent limitations of ESM such as limited depth penetration and risk of seizure elicitation, warrant the development of new image-guided resection tools. Here, we present functional Ultrasound (fUS)-imaging as a new, high-resolution tool to guide intra-operative decision-making during awake tumor removal. METHODS fUS relies on high-frame-rate ultrasound, which offers images at thousands of frames-per-second. As such, fUS is sensitive to very small motions caused by vascular dynamics (µDoppler), allowing measurements of changes in cerebral blood volume (CBV). This facilitates the possibility to 1) detect functional response, as CBV-changes reflect changes in metabolism of activated neurons through neurovascular coupling and 2) visualize high-resolution vascular morphology of tumor and healthy tissue. During conventional awake craniotomy surgery, n= 10 patients were asked to perform 60s functional tasks to elicit cortical responses. Simultaneously, a conventional 5 MHz ultrasound probe connected to an experimental acquisition system, was placed over ESM-defined functional areas. After image acquisition, correlation analyses with the corresponding tasks revealed functional and non-functional areas. In addition, 3D vascular maps were reconstructed from subsequent 2D-Power Doppler Images (PDIs). RESULTS fUS was able to detect functional areas as activated using conventional motor tasks, as well as complex language-related tasks. In addition, both 2D-PDIs and 3D-reconstructions revealed the ability of fUS to detect unique high-resolution onco-vascular characteristics in high- and low-grade malignancies. In all cases, images were acquired with micrometer-millisecond (300 µm, 1.5-2.0 msec) precision at imaging depths > 5 cm. CONCLUSIONS Applying fUS-imaging successfully in this awake craniotomy series serves as a clear demonstration of the technique’s revolutionary potential for maximizing safe tumor removal.

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