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.

Prospective study of awake craniotomy used routinely and nonselectively for supratentorial tumors

2007 ◽  
Vol 107 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Demitre Serletis ◽  
Mark Bernstein
Keyword(s):  
General Anesthesia ◽  
Brain Mapping ◽  
Tumor Resection ◽  
Tumor Location ◽  
Awake Craniotomy ◽  
Neurological Deficits ◽  
Wound Complications ◽  
Presenting Symptoms ◽  
Eloquent Cortex ◽  
Supratentorial Tumors

Object The authors prospectively assessed the value of awake craniotomy used nonselectively in patients undergoing resection of supratentorial tumors. Methods The demographic features, presenting symptoms, tumor location, histological diagnosis, outcomes, and complications were documented for 610 patients who underwent awake craniotomy for supratentorial tumor resection. Intraoperative brain mapping was used in 511 cases (83.8%). Mapping identified eloquent cortex in 115 patients (22.5%) and no eloquent cortex in 396 patients (77.5%). Results Neurological deficits occurred in 89 patients (14.6%). In the subset of 511 patients in whom brain mapping was performed, 78 (15.3%) experienced postoperative neurological worsening. This phenomenon was more common in patients with preoperative neurological deficits or in those individuals in whom mapping successfully identified eloquent tissue. Twenty-five (4.9%) of the 511 patients suffered intraoperative seizures, and two of these individuals required intubation and induction of general anesthesia after generalized seizures occurred. Four (0.7%) of the 610 patients developed wound complications. Postoperative hematomas developed in seven patients (1.1%), four of whom urgently required a repeated craniotomy to allow evacuation of the clot. Two patients (0.3%) required readmission to the hospital soon after being discharged. There were three deaths (0.5%). Conclusions Awake craniotomy is safe, practical, and effective during resection of supratentorial lesions of diverse pathological range and location. It allows for intraoperative brain mapping that helps identify and protect functional cortex. It also avoids the complications inherent in the induction of general anesthesia. Awake craniotomy provides an excellent alternative to surgery of supratentorial brain lesions in patients in whom general anesthesia has been induced.

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.

scholarly journals Long-Term Results of Neurological Outcome, Quality of Life, and Cosmetic Outcome After Cranioplastic Surgery: A Single Center Study of 202 Patients

2021 ◽  
Vol 12 ◽  
Author(s):  
Henrik Giese ◽  
Jennifer Antritter ◽  
Andreas Unterberg ◽  
Christopher Beynon
Keyword(s):  
Quality Of Life ◽  
Regression Analysis ◽  
Neurological Outcome ◽  
Long Term Results ◽  
Complication Rates ◽  
Long Term Outcome ◽  
Sf 36

Objective: An increased interest in the surgical procedures of decompressive craniectomy (DC) and subsequent cranioplasty (CP) has emerged during the last decades with specific focus on mortality and complication rates. The aim of the present study was to evaluate long-term neurological and cosmetic outcomes as well as Quality of Life (QoL) after CP surgery.Methods: We retrospectively reviewed the medical records of CP patients treated at our institution between 2004 and 2014 and performed a follow-up examination, with evaluation of neurological outcome using the modified Rankin Scale (mRS) and the Glasgow outcome scale (GOS), QoL (SF-36 and EQ-5D-3L). Furthermore, the cosmetic results after CP were analyzed.Results: A total of 202 CP-patients were included in the present study. The main indications for DC and subsequent CP were space-occupying cerebral ischemia (32%), traumatic brain injury (TBI, 26%), intracerebral or subarachnoid hemorrhage (32%) and infection (10%). During a mean follow-up period of 91.9 months 46/42.6% of patients had a favorable neurological outcome (mRS ≤ 3/GOS ≥ 4). Patients with ischemia had a significant worse outcome (mRS 4.3 ± 1.5) compared with patients after TBI (3.1 ± 2.3) and infectious diseases requiring CP (2.4 ± 2.3). The QoL analysis showed that <1/3rd of patients (31.2%) had a good QoL (SF-36) with a mean EQ-5D-VAS of 59 ± 26. Statistical analysis confirmed a significant worse QoL of ischemia patients compared to other groups whereas multivariate regression analysis showed no other factors which may had an impact on the QoL. The majority (86.5%) of patients were satisfied with the cosmetic result after CP and regression analysis showed no significant factors associated with unfavorable outcomes.Conclusion: Long-term outcome and QoL after CP were significantly influenced by the medical condition requiring DC. Early detection and evaluation of QoL after CP may improve the patient's outcome due to an immediate initiation of targeted therapies (e.g., occupational- or physiotherapy).

The Patient for Epilepsy Surgery

2018 ◽  
Author(s):  
Haitham Ibrahim ◽  
Irene P. Osborn
Keyword(s):  
Quality Of Life ◽  
Patient Satisfaction ◽  
General Anesthesia ◽  
Epilepsy Surgery ◽  
Brain Mapping ◽  
Seizure Control ◽  
Intractable Epilepsy ◽  
Operating Conditions ◽  
Anticonvulsant Medication

Epilepsy surgery as a treatment option is usually reserved for medically intractable epilepsy, when anticonvulsant medication has failed to achieve adequate seizure control and the seizure frequency impairs quality of life. Intraoperative brain mapping is often requested by the surgeon and necessitates special planning by the anesthesiologist to provide the best possible operating conditions. Awake craniotomy with the “asleep-awake-asleep” pattern can be considered as a technique in such procedures but requires cautious management for achieving maximum patient satisfaction. Certain patients are not appropriate candidates for craniotomy in the awake state, but general anesthesia can still be considered with specific considerations.

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

Awake craniotomy with brain mapping as the routine surgical approach to treating patients with supratentorial intraaxial tumors: a prospective trial of 200 cases

1999 ◽  
Vol 90 (1) ◽  
pp. 35-41 ◽  
Author(s):  
Michael D. Taylor ◽  
Mark Bernstein
Keyword(s):  
Intensive Care ◽  
Surgical Approach ◽  
Brain Mapping ◽  
Prospective Trial ◽  
Awake Craniotomy ◽  
Neurological Deficits ◽  
Total Hospital ◽  
Content Type ◽  
Total Hospital Stay ◽  
Fine Print

Object. Awake craniotomy was performed as the standard surgical approach to supratentorial intraaxial tumors, regardless of the involvement of eloquent cortex, in a prospective trial of 200 patients surgically treated by the same surgeon at a single institution.Methods. Patient presentations, comorbid conditions, tumor locations, and the histological characteristics of lesions were recorded. Brain mapping was possible in 195 (97.5%) of 200 patients. The total number of patients sustaining complications was 33 for an overall complication rate of 16.5%. There were two deaths in this series, for a mortality rate of 1%. New postoperative neurological deficits were seen in 13% of the patients, but these were permanent in only 4.5% of them. Complication rates were higher in patients who had gliomas or preoperative neurological deficits and in those who had undergone prior radiation therapy or surgery. No patient who entered the operating room neurologically intact sustained a permanent neurological deficit postoperatively. Of the most recent 50 patients treated, three (6%) required a stay in the intensive care unit, and the median total hospital stay was 1 day.Conclusions. Use of awake craniotomy can result in a considerable reduction in resource utilization without compromising patient care by minimizing intensive care time and total hospital stay. Awake craniotomy is a practical and effective standard surgical approach to supratentorial tumors with a low complication rate, and provides an excellent alternative to craniotomy performed with the patient in the state of general anesthesia because it allows the opportunity for brain mapping and avoids general anesthesia.

scholarly journals Magnetoencephalographic Imaging of Resting-State Functional Connectivity Predicts Postsurgical Neurological Outcome in Brain Gliomas

Neurosurgery ◽  
2012 ◽  
Vol 71 (5) ◽  
pp. 1012-1022 ◽  
Author(s):  
Phiroz E. Tarapore ◽  
Juan Martino ◽  
Adrian G. Guggisberg ◽  
Julia Owen ◽  
Susanne M. Honma ◽  
...  
Keyword(s):  
Functional Connectivity ◽  
Brain Tumors ◽  
Resting State ◽  
Neurological Outcome ◽  
Preoperative Evaluation ◽  
Neurological Deficits ◽  
Medium Term ◽  
Eloquent Areas ◽  
Neurological Morbidity ◽  
Brain Gliomas

Abstract BACKGROUND: The removal of brain tumors in perieloquent or eloquent cortex risks causing new neurological deficits in patients. The assessment of the functionality of perilesional tissue is essential to avoid postoperative neurological morbidity. OBJECTIVE: To evaluate preoperative magnetoencephalography-based functional connectivity as a predictor of short- and medium-term neurological outcome after removal of gliomas in perieloquent and eloquent areas. METHODS: Resting-state whole-brain magnetoencephalography recordings were obtained from 79 consecutive subjects with focal brain gliomas near or within motor, sensory, or language areas. Neural activity was estimated using adaptive spatial filtering. The mean imaginary coherence between voxels in and around brain tumors was compared with contralesional voxels and used as an index of their functional connectivity with the rest of the brain. The connectivity values of the tissue resected during surgery were correlated with the early (1 week postoperatively) and medium-term (6 months postoperatively) neurological morbidity. RESULTS: Patients undergoing resection of tumors with decreased functional connectivity had a 29% rate of a new neurological deficit 1 week after surgery and a 0% rate at 6-month follow-up. Patients undergoing resection of tumors with increased functional connectivity had a 60% rate of a new deficit at 1 week and a 25% rate at 6 months. CONCLUSION: Magnetoencephalography connectivity analysis gives a valuable preoperative evaluation of the functionality of the tissue surrounding tumors in perieloquent and eloquent areas. These data may be used to optimize preoperative patient counseling and surgical strategy.

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.

Elective Stenting for Intracranial Stenosis Under Conscious Sedation

Neurosurgery ◽  
2010 ◽  
Vol 67 (5) ◽  
pp. 1189-1194 ◽  
Author(s):  
Andrea J Chamczuk ◽  
Christopher S Ogilvy ◽  
Kenneth V Snyder ◽  
Hajime Ohta ◽  
Adnan H Siddiqui ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Conscious Sedation ◽  
Effective Means ◽  
Postoperative Management ◽  
Intracranial Stenosis ◽  
Neurological Deficits ◽  
Complication Rates ◽  
Intracranial Stenting ◽  
Anesthetic Agents ◽  
Permanent Neurological Deficit

Abstract BACKGROUND: Elective stenting for intracranial stenosis is under study as an effective means of reducing stroke risk. At most institutions, these procedures are performed and monitored after the induction of general anesthesia. OBJECTIVE: To report our success with elective intracranial stenting and angioplasty performed in conscious patients after the administration of mild sedatives and local anesthetic agents. METHODS: We retrospectively evaluated data from 66 patients who underwent elective intracranial stenting for atherosclerosis. Sixty-one procedures were performed under local anesthesia with mild sedation; 3 were performed under general anesthesia, and 2 were converted from local to general anesthesia during the procedure. Intraprocedural neurological changes were monitored and led to reevaluation of technique, immediate reimaging, modifying the endovascular procedure itself, or possibly mandating conversion to general anesthesia. RESULTS: Thirty-nine anterior and 27 posterior circulation stenotic segments were treated. Angiographic success was achieved in 95.5% of patients with an overall reduction in stenosis of 75.5 to 22.3%. Percutaneous angioplasty and stenting were used in 58 cases; 8 patients were treated with stenting alone. Three patients (4.9%) developed neurological deficits mandating alteration or adjustment of endovascular technique or immediate postoperative management to avoid permanent sequelae. A total of 8 periprocedural complications occurred, 2 of which resulted in permanent neurological deficit. The overall mortality rate was 3.2%. CONCLUSIONS: Stenting of intracranial atherosclerosis performed under conscious sedation is associated with complication rates and effectiveness similar to historical rates for general anesthesia. Conscious sedation confers the additional benefit of continuous neurological assessment during the procedure.

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