An Update of Neuroanesthesia for Intraoperative Brain Mapping Craniotomy

Abstract

The perioperative multidisciplinary team approach has probably been best exemplified by the care of awake craniotomy patients. Advancement in anesthesia and meticulous perioperative care has supported the safety and complexity of the surgical and mapping efforts in glioma resection. The discussions in this review will emphasize on anesthetic and perioperative management strategies to prevent complications and minimize their effects if they occur, including current practice guidelines in anesthesia, updates on the applications of anesthetic medications, and emerging devices. Planning the anesthetic and perioperative management is based on understanding the pharmacology of the medications, the goals of different stages of the surgery and mapping, and anticipating potential problems.

Anesthetic Selection for an Awake Craniotomy for a Glioma With Wernicke’s Aphasia: A Case Report

“…Awake craniotomies for tumor resections allow for the preservation of eloquent cortex and have been associated with improved overall and malignancy-free survival [ 1 ]. However, these are high-risk surgeries that require careful patient selection and meticulous intraoperative anesthetic management [ 1 , 3 ]. Patients who are unlikely to tolerate the awake portion of the procedure, such as those with high baseline anxiety, are often excluded [ 1 ].…”

“…However, these are high-risk surgeries that require careful patient selection and meticulous intraoperative anesthetic management [ 1 , 3 ]. Patients who are unlikely to tolerate the awake portion of the procedure, such as those with high baseline anxiety, are often excluded [ 1 ]. Patients with respiratory disease, such as sleep apnea, may also be excluded due to concern for intraoperative respiratory failure with limited airway access [ 1 ].…”

“…Patients who are unlikely to tolerate the awake portion of the procedure, such as those with high baseline anxiety, are often excluded [ 1 ]. Patients with respiratory disease, such as sleep apnea, may also be excluded due to concern for intraoperative respiratory failure with limited airway access [ 1 ]. From a neuropathological standpoint, patients with severe preoperative aphasias are excluded as they cannot participate in intraoperative language mapping [ 2 ].…”

“…Preoperative patient selection is critical to a successful awake craniotomy because patients must be physically and psychologically capable of being safely kept awake for intraoperative cortical mapping and continuous language monitoring [ 1 ]. Patients with severe preoperative speech and language deficits are often excluded because they cannot meaningfully participate during intraoperative language mapping [ 2 ].…”

Updates in Neuroanesthesia

“…Over the last 40 years, intraoperative cortical and subcortical brain mapping has led to major improvements in both recurrence-free survival and postoperative outcomes in patients undergoing resective brain surgery [15]. The primary goal of mapping is to identify and preserve tissue associated with speech and motor function while also ensuring adequate margins during mass resection [15].…”