Anesthetic Management of Awake Craniotomy for Resection of the Language and Motor Cortex Vascular Malformations

Wang, Annie Ting; Pillai, Padmanabhan; Guran, Elyse; Carter, Harmony; Minasian, Tanya; Lenart, John; Vandse, Rashmi

doi:10.1016/j.wneu.2020.07.050

Cited by 14 publications

(20 citation statements)

References 32 publications

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“…We con rm that the potential bene t of awake surgery for AVMs resection has to balance against the potential intra-operative risks of compromising airway protection, blood pressure control or seizures [23], preservation of neurological function, delineating epileptogenic foci, improving the sensitivity of neuromonitoring, and mitigating the side effects of general anesthesia [1].…”

Section: Discussionmentioning

confidence: 99%

“…When functional mapping is required, ESM remains the gold standard. Throughout the years, several modalities of non-invasive functional imaging, like fMRIs, PET, and DTI, have augmented but not yet supplanted this more invasive procedure [1] that allows identi cation of a non-eloquent gyrus for intervention and can potentially facilitate resection with preservation of functions [23].…”

Section: Discussionmentioning

confidence: 99%

“…AVMs located in the motor and language cortex are associated with signi cant risk of neurological deterioration, especially in patients presenting with unruptured AVMs and minimal or no neurological de cits. These patients are typically managed conservatively or treated radio-surgically, [10] so, the surgical treatment of AVMs located in an eloquent area represents a therapeutic challenge [10,23].…”

Section: Introductionmentioning

confidence: 99%

“…To promote the analysis we considered the reported cases from all other series published in the literature. We found six published series utilizing awake cortical mapping for preservation of function during AVM resection [1,5,10,23,24]. We implemented the Awake Group with results from the most complete case series reported in the literature to obtain a complete uni and multivariate analysis of surgical risks and outcome.…”

Section: Introductionmentioning

confidence: 99%

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Awake Surgery for Arteriovenous Malformations (AVM) in Eloquent Area: Risk and Outcome Analysis in the Most Complete Case-Collection

Armocida

D’Angelo

Pesce

et al. 2021

Preprint

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Background: Artero-venous malformations (AVMs) located in eloquent area are associated with significant risk of neurological deterioration, especially in patients presenting with unruptured AVMs and minimal or no neurological deficits. Awake-surgery allows a better identification of eloquent gyrus, but its feasibility and application in resection of eloquent AVMs is controversial and mostly limited to small case series.Methods: A total of 31 patients suffering from intracranial AVMs have been operated on in our Department. Patients were stratified into two groups: patients submitted to Asleep Surgery and patients submitted to Awake surgery. We implemented the Awake Group with results from the most complete case series reported in the literature to obtain a complete uni and multivariate analysis of surgical risks and outcome.Results: Awake craniotomy was performed in 19,35% of the AVMs treated in our centre. Considering the reported cases from all other series published in the literature, we obtained a comparison between the asleep group of 25 patients derived from our series and the awake group of 34 patients. No statistically significant differences were identified regarding the risk of postoperative complications, surgical radicality, presence of residual, and need for adjuvant treatment. Interestingly, however, improvement in performance status was more rapid and effective during follow-up in patients treated with awake surgery compared with asleep surgery.Conclusions: In contrast to what is commonly believed, applying awake surgery in this type of lesions does not involve increased intra-operative risks, but rather it seems to determine a greater improvement in the outcome of patients from the thirtieth postoperative day. Awake patients allow for more precise brain mapping and superior clinical neurologic monitoring, which facilitates resection by defining the safe margins without an increased risk.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Awake Surgery for Arteriovenous Malformations (AVM) in Eloquent Area: Risk and Outcome Analysis in the Most Complete Case-Collection

Armocida

D’Angelo

Pesce

et al. 2021

Preprint

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“…We successfully performed an asleep-awake-asleep technique for ABI surgery following acoustic neuroma resections via the retrosigmoid approach in three NF2 patients. Awake craniotomy is usually performed to maximize resection of tumors near the eloquent area[ 3 , 4 ]. It can reduce anesthetic interference with brain mapping[ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Awake craniotomy for auditory brainstem implant in patients with neurofibromatosis type 2: Four case reports

Wang

Jian

et al. 2021

WJCC

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BACKGROUND The auditory brainstem implant (ABI) is a significant treatment to restore hearing sensations for neurofibromatosis type 2 (NF2) patients. However, there is no ideal method in assisting the placement of ABIs. In this case series, intraoperative cochlear nucleus mapping was performed in awake craniotomy to help guide the placement of the electrode array. CASE SUMMARY We applied the asleep-awake-asleep technique for awake craniotomy and hearing test via the retrosigmoid approach for acoustic neuroma resections and ABIs, using mechanical ventilation with a laryngeal mask during the asleep phases, utilizing a ropivacaine-based regional anesthesia, and sevoflurane combined with propofol/remifentanil as the sedative/analgesic agents in four NF2 patients. ABI electrode arrays were placed in the awake phase with successful intraoperative hearing tests in three patients. There was one uncooperative patient whose awake hearing test needed to be aborted. In all cases, tumor resection and ABI were performed safely. Satisfactory electrode effectiveness was achieved in awake ABI placement. CONCLUSION This case series suggests that awake craniotomy with an intraoperative hearing test for ABI placement is safe and well tolerated. Awake craniotomy is beneficial for improving the accuracy of ABI electrode placement and meanwhile reduces non-auditory side effects.

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An update on tests used for intraoperative monitoring of cognition during awake craniotomy

de Zwart,

Ruis

2024

Acta Neurochir

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Purpose Mapping higher-order cognitive functions during awake brain surgery is important for cognitive preservation which is related to postoperative quality of life. A systematic review from 2018 about neuropsychological tests used during awake craniotomy made clear that until 2017 language was most often monitored and that the other cognitive domains were underexposed (Ruis, J Clin Exp Neuropsychol 40(10):1081–1104, 218). The field of awake craniotomy and cognitive monitoring is however developing rapidly. The aim of the current review is therefore, to investigate whether there is a change in the field towards incorporation of new tests and more complete mapping of (higher-order) cognitive functions. Methods We replicated the systematic search of the study from 2018 in PubMed and Embase from February 2017 to November 2023, yielding 5130 potentially relevant articles. We used the artificial machine learning tool ASReview for screening and included 272 papers that gave a detailed description of the neuropsychological tests used during awake craniotomy. Results Comparable to the previous study of 2018, the majority of studies (90.4%) reported tests for assessing language functions (Ruis, J Clin Exp Neuropsychol 40(10):1081–1104, 218). Nevertheless, an increasing number of studies now also describe tests for monitoring visuospatial functions, social cognition, and executive functions. Conclusions Language remains the most extensively tested cognitive domain. However, a broader range of tests are now implemented during awake craniotomy and there are (new developed) tests which received more attention. The rapid development in the field is reflected in the included studies in this review. Nevertheless, for some cognitive domains (e.g., executive functions and memory), there is still a need for developing tests that can be used during awake surgery.

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Anesthetic Management of Awake Craniotomy for Resection of the Language and Motor Cortex Vascular Malformations

Cited by 14 publications

References 32 publications

Awake Surgery for Arteriovenous Malformations (AVM) in Eloquent Area: Risk and Outcome Analysis in the Most Complete Case-Collection

Awake Surgery for Arteriovenous Malformations (AVM) in Eloquent Area: Risk and Outcome Analysis in the Most Complete Case-Collection

Awake craniotomy for auditory brainstem implant in patients with neurofibromatosis type 2: Four case reports

An update on tests used for intraoperative monitoring of cognition during awake craniotomy

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