Awake Craniotomy for Brain Tumor Resection

Brown, Tyler; Shah, Ashish H.; Bregy, Amadé; Shah, Nirav; Thambuswamy, Michael; Barbarite, Eric; Fuhrman, Thomas M.; Komotar, Ricardo J.

doi:10.1097/ana.0b013e318290c230

Cited by 124 publications

(49 citation statements)

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“…remifentanil). A recent systematic review showed that awake brain tumor resection led to a better perioperative neurological outcome compared with surgery under general anesthesia; moreover, AC was consistently associated with shorter hospital stay, less resource utilization, and high patient satisfaction 13 . Major intraoperative complications during AC include respiratory depression, arterial hypertension, nausea and vomiting, air embolisms, brain swelling, seizures and loss of patient cooperation 14 .…”

Section: Discussionmentioning

confidence: 99%

Case Report: Emergency awake craniotomy for cerebral abscess in a patient with unrepaired cyanotic congenital heart disease

et al. 2017

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We report the case of a 39-year-old male with complex cyanotic congenital heart disease undergoing emergency craniotomy for a cerebral abscess. Maintenance of intraoperative hemodynamic stability and adequate tissue oxygenation during anesthesia may be challenging in patients with cyanotic congenital heart disease. In this case, we decided to perform the surgery as an awake craniotomy after interdisciplinary consensus. We discuss general aspects of anesthetic management during awake craniotomy and specific concerns in the perioperative care of patients with congenital heart disease.

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Section: Discussionmentioning

confidence: 99%

Case Report: Emergency awake craniotomy for cerebral abscess in a patient with unrepaired cyanotic congenital heart disease

et al. 2017

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“…By contrast, factors that increase LOS include preoperative comorbidities, prolonged operative time, fluid volume infused intraoperatively, intraoperative blood loss, and time to tolerate oral fluids postoperatively . Moreover, the surgical procedure itself has been shown to impact LOS as patients undergoing awake craniotomies have a shorter LOS than those treated with craniotomies under general anesthesia …”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6] Moreover, the surgical procedure itself has been shown to impact LOS as patients undergoing awake craniotomies have a shorter LOS than those treated with craniotomies under general anesthesia. 7 In contrast to adult brain tumor patients, there is a paucity of literature on factors that influence LOS in pediatric neuro-oncology. The limited available data on LOS in pediatric brain tumor patients have identified postoperative wound infections, 8 posterior fossa tumor resection, 8,9 intraoperative blood loss, and difficult extubation 10 to prolong LOS.…”

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confidence: 99%

Analysis of factors that influence neurosurgical length of hospital stay among newly diagnosed pediatric brain tumor patients

Hasan

Diep

Manoranjan

et al. 2019

Pediatric Blood & Cancer

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Background Postoperative length of stay (LOS) carries a high burden of healthcare costs. In resource‐intense specialties such as neurosurgery, it is imperative to identify factors that influence LOS to improve care. The current study investigates the potential for variables that affect clinical presentation, tumor characteristics, treatment modalities, and postoperative complications to impact overall LOS in pediatric brain tumor patients. Methods A retrospective cohort study design was used with patients enrolled in the McMaster Pediatric Brain Tumor Study Group database. All patients up to 18 years of age, presenting with a newly diagnosed brain tumor admitted to and discharged from neurosurgery, were included. Patients were sorted into three cohorts: short LOS (≤3 days), extended LOS (≥20 days), and control LOS (4‐19 days). Results Of the 124 patients included, 20 (65% male; median age: 9.1 years; range, 0.8‐17.4 years) were considered short LOS, 28 (61% male; median age: 4.7 years; range, 0.4‐14.7 years) were considered extended LOS, and 76 (57% male; median age: 8.5 years; range, 0.3–17.9 years) were considered control LOS. Variables that prolonged LOS were emesis at presentation (P < 0.001), developmental delay (P = 0.02), multiple surgeries (P = 0.004), tumor location (P < 0.05), subtotal resection (P = 0.02), feeding tube (P < 0.001), adjuvant chemoradiotherapy (P < 0.001), and posterior fossa syndrome (P = 0.004). Conclusions This study identifies variables related to clinical presentation, tumor characteristics, treatment modalities, and postoperative complications associated with extended LOS. These findings uncover novel predictors of LOS that can be used to guide future research and improve health resource management.

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“…Studies have demonstrated that up to 50% of patients with acute subarachnoid hemorrhage (SAH) suffer from some degree of neurological impairment after aneurysm clipping [1,2]. In patients with acute stroke who have a high rate of neurological morbidity, therapies that provide neuroprotection are the mainstay of clinical management [3,4].…”

Section: Introductionmentioning

confidence: 99%

Cerebral protection during neurosurgery and stroke

Badenes

Gruenbaum

Bilotta

2015

Current Opinion in Anaesthesiology

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Purpose of review This article reviews the recent evidence on perioperative neuroprotection in patients undergoing brain surgery and in patients with acute stroke. Recent findings With varying degrees of success, numerous pharmacological and nonpharmacological therapies have been employed to provide neuroprotection for patients during the perioperative period and after acute ischemic stroke (IAS). Recent studies have failed to demonstrate neuroprotective effects of intraoperative remifentanil or propofol use, although hypertonic saline may provide better brain relaxation than mannitol during elective intracranial surgery for tumor. Magnesium sulfate offers no improvement in neurological outcome at 90 days after stroke. Medical management alone may be superior to medical management with interventional therapy for the prevention of death or stroke in unruptured arteriovenous malformations. In patients with IAS with a proximal vessel occlusion, small infarct core, and moderate-to-good collateral circulation, rapid endovascular treatment resulted in improved functional outcomes and reduced mortality. For endovascular clot evacuation after IAS, conscious sedation may be safer than general anaesthesia. Summary Recent evidence provides insufficient evidence of neuroprotective strategies to guide clinical management, and more randomized clinical trials are needed to optimize patient care.

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Awake Craniotomy for Brain Tumor Resection

Abstract: Given the effectiveness of AC for resection of eloquent tumors, the data suggests an expanded role for AC in brain tumor surgery regardless of tumor location.

Cited by 124 publications

References 0 publications

Case Report: Emergency awake craniotomy for cerebral abscess in a patient with unrepaired cyanotic congenital heart disease

Case Report: Emergency awake craniotomy for cerebral abscess in a patient with unrepaired cyanotic congenital heart disease

Analysis of factors that influence neurosurgical length of hospital stay among newly diagnosed pediatric brain tumor patients

Cerebral protection during neurosurgery and stroke

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