scholarly journals Anaesthetic Management of Left Temporal Glioma Undergoing Awake Craniotomy

2021 ◽  
pp. 1-5
Author(s):  
Roshan Nisal ◽  
Vasam Rajesh Kumar ◽  
Wankhade Prachi Pandit ◽  
Sanjot Ninave
Keyword(s):  
Anaesthetic Management ◽  
Operating Conditions ◽  
Awake Craniotomy ◽  
Language Mapping ◽  
Complete Excision ◽  
Motor Mapping ◽  
Patient Cooperation ◽  
Scalp Block ◽  
Anaesthesia Care ◽  
Motor And Language Mapping

For an awake craniotomy, a 49 year old (ASA 2), 78 kg woman with type II DM was given regional anaesthesia (scalp block) with monitored anaesthesia care (MAC). She had a headache, which was primarily caused by a left temporal glioma. She was very apprehensive about having this procedure done while she was awake. Fentanyl and Dexmedetomidine infusions in combination with scalp block initially provided adequate operating conditions. Because the patient needed to be fully awake, alert and cooperative during the language and motor mapping, all sedation was turned off. Patient was cooperative and obeyed commands during motor and language mapping as well as during tumour excision. Patient underwent complete excision of tumour without any postoperative neurological deficit. The success of the awake craniotomy  is dependent on the patient cooperation, anaesthesiologist's experience, adequate intraoperative analgesia coverage, careful sedation titration, and meticulous planning.

scholarly journals Utilization of awake craniotomy for supra-tentorial tumor resection during pregnancy: A technique useful for fetal-maternal wellbeing

2019 ◽  
Vol 36 (2) ◽  
Author(s):  
Dileep Kumar ◽  
Sheema Siraj ◽  
Khalid Ahsan ◽  
Faraz Shafiq
Keyword(s):  
Benign Tumor ◽  
Tumor Resection ◽  
Anaesthetic Management ◽  
Awake Craniotomy ◽  
Creative Commons ◽  
Scalp Block ◽  
Fetal Wellbeing ◽  
The Impact ◽  
Maternal Wellbeing ◽  
Open Access Article

Meningioma is the benign tumor that can also occurs during pregnancy. We are reporting a case of 29 years, 13th weeks pregnant lady, who underwent supratentorial craniotomy using awake through out approach. The case report highlights the challenges we faced during anaesthetic management, which includes psychological preparation, institution of scalp block and successful neurological monitoring. Technique proven to be useful considering pregnancy related physiological and tumor related pathological changes, the impact of which lies directly on maternal & fetal wellbeing. doi: https://doi.org/10.12669/pjms.36.2.1853 How to cite this:Kumar D, Siraj S, Ahsan K, Shafiq F. Utilization of awake craniotomy for supra-tentorial tumor resection during pregnancy: A technique useful for fetal-maternal wellbeing. Pak J Med Sci. 2020;36(2):---------. doi: https://doi.org/10.12669/pjms.36.2.1853 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Patient Reported Experience Measures in navigated Transcranial Magnetic Stimulation

2019 ◽  
Vol 21 (Supplement_4) ◽  
pp. iv15-iv15
Author(s):  
Sabina Patel ◽  
José Lavrador ◽  
Prajwal Ghimire ◽  
Richard Gullan ◽  
Keyoumars Ashkan ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Patient Experience ◽  
Magnetic Stimulation ◽  
Navigated Transcranial Magnetic Stimulation ◽  
Language Mapping ◽  
College Hospital ◽  
Motor Mapping ◽  
Non Invasive ◽  
Patient Reported ◽  
Motor And Language Mapping

Abstract Introduction Navigated Transcranial Magnetic Stimulation (nTMS) is a non-invasive adjunct used in surgical planning for lesions in eloquent brain. However, its patient tolerability and effect on their overall healthcare experience is still unknown. To our knowledge, there is no other literature available evaluating patient experience with nTMS. Methods A single-institution prospective cohort study carried out between February 2018 and December 2018 at King’s College Hospital. All patients were supplied with a PREMs-TMS questionnaire to evaluate the different domains of the nTMS experience. Results Feedback was obtained from 50 patients. 26% of patients underwent motor mapping (MM), whilst 74% underwent both motor and language mapping (MLM). The former group reported a better overall experience (p=0.020). The mean exam duration was 103.3±5.1 min (MM 85.8±6.1 min; MLM 106.9±5.9 min). The whole experience of nTMS received positive feedback (94%), particularly with confidence in the staff (95%). Unsurprisingly, the exam domain received a poorer rating (70% as good) with significant anxiety and pain reported in 26% and 24% of patients respectively. None of the studied variables influenced the way patients rated the overall experience of nTMS (p>0.05). Conclusions nTMS is a non-invasive investigative tool, which allows patients to better understand their condition and symptoms related to their lesion. Serial assessment and feedback using a PREM tool, can only improve and enhance this experience. Departmental collaboration may be useful in comparing patient experience with nTMS in different centres.

scholarly journals Accuracy analysis of fMRI and MEG activations determined by intraoperative mapping

2020 ◽  
Vol 48 (2) ◽  
pp. E13 ◽  
Author(s):  
David G. Ellis ◽  
Matthew L. White ◽  
Satoru Hayasaka ◽  
David E. Warren ◽  
Tony W. Wilson ◽  
...  
Keyword(s):  
Functional Neuroimaging ◽  
Lower Sensitivity ◽  
Language Mapping ◽  
Mapping Accuracy ◽  
Clinical Trial Registration ◽  
Distance Threshold ◽  
Motor Mapping ◽  
Maximum Accuracy ◽  
The Individual ◽  
Motor And Language Mapping

OBJECTIVEBy looking at how the accuracy of preoperative brain mapping methods vary according to differences in the distance from the activation clusters used for the analysis, the present study aimed to elucidate how preoperative functional neuroimaging may be used in such a way that maximizes the mapping accuracy.METHODSThe eloquent function of 19 patients with a brain tumor or cavernoma was mapped prior to resection with both functional MRI (fMRI) and magnetoencephalography (MEG). The mapping results were then validated using direct cortical stimulation mapping performed immediately after craniotomy and prior to resection. The subset of patients with equivalent MEG and fMRI tasks performed for motor (n = 14) and language (n = 12) were evaluated as both individual and combined predictions. Furthermore, the distance resulting in the maximum accuracy, as evaluated by the J statistic, was determined by plotting the sensitivities and specificities against a linearly increasing distance threshold.RESULTSfMRI showed a maximum mapping accuracy at 5 mm for both motor and language mapping. MEG showed a maximum mapping accuracy at 40 mm for motor and 15 mm for language mapping. At the standard 10-mm distance used in the literature, MEG showed a greater specificity than fMRI for both motor and language mapping but a lower sensitivity for motor mapping. Combining MEG and fMRI showed a maximum accuracy at 15 mm and 5 mm—MEG and fMRI distances, respectively—for motor mapping and at a 10-mm distance for both MEG and fMRI for language mapping. For motor mapping, combining MEG and fMRI at the optimal distances resulted in a greater accuracy than the maximum accuracy of the individual predictions.CONCLUSIONSThis study demonstrates that the accuracy of language and motor mapping for both fMRI and MEG is heavily dependent on the distance threshold used in the analysis. Furthermore, combining MEG and fMRI showed the potential for increased motor mapping accuracy compared to when using the modalities separately.Clinical trial registration no.: NCT01535430 (clinicaltrials.gov)

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.

Abstract 3734: Presurgical fMRI and Morbidity Outcomes in Patients with Vascular Lesions

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Andrew C Radtke ◽  
Joshua Pankratz ◽  
Ryan Holdsworth ◽  
Dovile Baniulis ◽  
Nicole Kornder ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Preoperative Planning ◽  
Binary Logistic Regression ◽  
Vascular Lesion ◽  
Vascular Lesions ◽  
Motor Deficits ◽  
Binary Logistic Regression Analysis ◽  
Language Mapping ◽  
Motor Mapping ◽  
The Relationship

Background fMRI is being increasingly used as an adjunct imaging technique for preoperative planning for patients with various brain lesions. The proximity of the lesion to eloquent cortex is a major factor in guiding surgical planning. Our group has previously reported significant association between the distance between brain tumor periphery and area of fMRI activation (Lesion-Activation Distance; LAD) and morbidity and mortality outcomes. This study investigated the relationship between vascular lesion LAD and morbidity. Methods This study was a retrospective analysis of data from patients with vascular lesions [arteriovenous malformations (AVMs) (n=49), and cavernomas (n=57)], who had received fMRI as part of their preoperative planning. The preoperative fMRI included motor mapping (n=87) and/or language mapping (n=102). The fMRI paradigms were chosen based on observed preoperative weakness (aphasia, paresis) and anticipated functional areas of the brain that may be affected by treatment. Results Multiple logistic regression analyses showed that a model that combines Age and Language LAD was a significant predictor of postoperative deficits (p= 0.04). Broca’s LAD(1-2 cm) X Age was a significant predictor of postoperative deficits (change in odds ratio (OR) =0.82, CI:0.68-0.98). The relationship between Brocas’s LAD and postoperative aphasia and Broca’s LAD and pre and postoperative aphasia trended towards significance (p = .08 and p =.07 respectively). Wernicke’s LAD, independently or combined with Age, was not a significant predictor of postoperative deficits. Binary logistic regression analysis for SMC LAD and postop deficits did not reach significance (p =.10). There were no significant differences in postoperative language or motor deficits as a function of gender or handedness. Conclusions These results suggest that both age and the proximity of a vascular lesion to language LAD are factors that can help predict postoperative outcomes, especially for Broca’s LAD. The lack of similar results when investigating the relationship between Wernicke’s LAD and postoperative deficits suggests potential brain reorganization and/or robustness of this brain region. These results have implications for the potential use of fMRI as a presurgical tool for language mapping in patients with vascular lesions.

scholarly journals Use of the train-of-five bipolar technique to provide reliable, spatially accurate motor cortex identification in asleep patients

2020 ◽  
Vol 48 (2) ◽  
pp. E4 ◽  
Author(s):  
Evan D. Bander ◽  
Evgeny Shelkov ◽  
Oleg Modik ◽  
Padmaja Kandula ◽  
Steven C. Karceski ◽  
...  
Keyword(s):  
Motor Cortex ◽  
High Frequency ◽  
Tumor Resection ◽  
Low Frequency ◽  
Retrospective Chart Review ◽  
High Frequency Stimulation ◽  
Language Mapping ◽  
Motor Mapping ◽  
Additional Tool ◽  
Bipolar Stimulation

OBJECTIVEIntraoperative cortical and subcortical mapping techniques have become integral for achieving a maximal safe resection of tumors that are in or near regions of eloquent brain. The recent literature has demonstrated successful motor/language mapping with lower rates of stimulation-induced seizures when using monopolar high-frequency stimulation compared to traditional low-frequency bipolar stimulation mapping. However, monopolar stimulation carries with it disadvantages that include more radiant spread of electrical stimulation and a theoretically higher potential for tissue damage. The authors report on the successful use of bipolar stimulation with a high-frequency train-of-five (TOF) pulse physiology for motor mapping.METHODSBetween 2018 and 2019, 13 patients underwent motor mapping with phase-reversal and both low-frequency and high-frequency bipolar stimulation. A retrospective chart review was conducted to determine the success rate of motor mapping and to acquire intraoperative details.RESULTSThirteen patients underwent both high- and low-frequency bipolar motor mapping to aid in tumor resection. Of the lesions treated, 69% were gliomas, and the remainder were metastases. The motor cortex was identified at a significantly greater rate when using high-frequency TOF bipolar stimulation (n = 13) compared to the low-frequency bipolar stimulation (n = 4) (100% vs 31%, respectively; p = 0.0005). Intraoperative seizures and afterdischarges occurred only in the group of patients who underwent low-frequency bipolar stimulation, and none occurred in the TOF group (31% vs 0%, respectively; p = 0.09).CONCLUSIONSUsing a bipolar wand with high-frequency TOF stimulation, the authors achieved a significantly higher rate of successful motor mapping and a low rate of intraoperative seizure compared to traditional low-frequency bipolar stimulation. This preliminary study suggests that high-frequency TOF stimulation provides a reliable additional tool for motor cortex identification in asleep patients.

Awake Craniotomy for Tumour, Epilepsy, and Functional Neurosurgery

2019 ◽  
pp. 235-244
Author(s):  
Lashmi Venkatraghavan ◽  
Pirjo Manninen
Keyword(s):  
Epilepsy Surgery ◽  
Brain Function ◽  
Anaesthetic Management ◽  
Awake Craniotomy ◽  
Epileptic Focus ◽  
Awake Patient ◽  
Functional Neurosurgery ◽  
Deep Brain Stimulator ◽  
Deep Brain

An awake craniotomy for tumour and epilepsy surgery allows for the mapping of eloquent brain function to minimize its injury and/or for the localization of an epileptic focus. The insertion of deep brain stimulators for the treatment of functional neurosurgical disorders is also frequently performed with an awake patient. The role of the anaesthetist is important in order to have a comfortable and cooperative patient, for the use of appropriate sedation to allow for mapping, and careful vigilance to rapidly diagnose and treat any complication. This chapter discusses the overall rationale for, and the anaesthetic management of, patients undergoing awake craniotomy for tumours, epilepsy surgery, or deep brain stimulator placement.

scholarly journals Scalp block for awake craniotomy: Lidocaine-bupivacaine versus lidocaine-bupivacaine with adjuvants

2020 ◽  
Vol 36 (1) ◽  
pp. 7-15
Author(s):  
Yasser M. Nasr ◽  
Salwa H. Waly ◽  
Ahmed A. Morsy
Keyword(s):  
Awake Craniotomy ◽  
Scalp Block
Sign in / Sign up

Export Citation Format

Share Document