The anesthesia for awake craniotomy (AC) is a consecrated anesthetic technique that has been perfected over the years. Initially used to map epileptic foci, it later became the standard technique for the removal of glial neoplasms in eloquent brain areas. We present an AC anesthesia technique consisting of three primordial times, called awake-asleep-awake, and their respective particularities, as well as delve into the anesthetic medications used. Its use in patients with low and high-grade gliomas was favorable for the resection of tumors within the functional boundaries of patients, with shorter hospital stay and lower direct costs. The present study aims to systematize the technique based on the experience of the largest philanthropic hospital in Latin America and discusses the most relevant aspects that have consolidated this technique as the most appropriate in the surgery of gliomas in eloquent areas.
BACKGROUND
Quality of life is essential for oncological patients. There are several tools that help surgery become more precise with less morbidity. Diode laser can cut and coagulate through thermal effect being helpful during surgery. It is a precise and useful technology that improves outcomes in neurooncology.
OBJECTIVES
To describe a pioneer case series of oncological use of diode laser and main applications of several types of laser in neurooncology.
METHODS
Detailed description of a pioneer case series of oncological patients that undergone to neurosurgical laser assisted procedures. An interventional longitudinal prospective study was conducted. Patients that had as mainly hypothesis the diagnosis of glioma or meningioma were selected. Also it was performed an extensive literature review about lasers in neurosurgery with special focus in diode laser.
RESULTS
There was not any paper describing the use of diode laser in neurooncology. The 980nm diode laser was used in 15 patients. The device had an easy handling. Decreased intra-operative time for hemostasis, lesser blood loss requiring less blood transfusion was observed. No post-operative complications occurred.
CONCLUSIONS
Diode laser is a useful tool for brain tumor surgery especially concerning hemostasis, providing decreased blood loss with lesser intra-operative duration. Surgical site coagulation is more effective causing less damage to adjacent structures specially in gliomas near eloquent regions. We consider this technique as a suitable adjuvant therapy for brain tumor surgeries providing an excellent hemostasis and helping cutting and vaporize lesion. This device makes surgery safer and decrease oncological morbidity.
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