Awake craniotomy without sedation in treatment of patients with lesional epilepsy

Ситников, А Р; Grigoryan, Yuri Alekseevich; Mishnyakova, L P

doi:10.4103/sni.sni_24_18

Cited by 14 publications

(7 citation statements)

References 33 publications

(38 reference statements)

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“…Cortical mapping, together with neurophysiological monitoring, could be applied for some more demanding tumours, although some surgeons prefer awake craniotomy [35]. Awake craniotomy also improves patient safety in terms of preserving speech functions [36]. The different location of both Broca and Wernicke area among individuals preclude the correct prediction of functionally active AF in DTI, what seems to be the main drawback of DTI tracking of AF, also confirmed by our experience.…”

Section: Arcuate Fasciculus (Af)supporting

confidence: 67%

The usefulness and limitations of diffusion tensor imaging – a review study

Kierońska¹,

Słoniewski²

2020

Eur J Trans Clin Med

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Diffusion tensor tractography (DTI) has been used for planning of a brain pathology surgeries. Knowledge about the distances between neural tracts and brain tumours is believed to increase the patient safety and implies the extent of resection. The aim of the study was to demonstrate the contemporary possibilities and the clinical usefulness of DTI. Following the explanation of the technical basics of DTI, we presented the drawbacks and limitations of this visualisation technique. The most commonly outlined tracts are corticospinal tract (CST), arcuate fasciculus (AF) and frontal aslant tract (FAT). Tumour located in frontal, parietal or temporal lobe can affect the course of the CST. There are two basic possibilities to visualise CST: deterministic and probabilistic. The usefulness of DTI seems limited in imaging the neoplasms of either frontal or temporal region causing aphasia, which infiltrate the AF or the FAT. This limitation is probably related to divergent and patient-specific location of functional speech areas. Acquisition disturbances, ill-defined mathematical algorithms, surgery-related brain shift and defining wrong non-functional brain area are the sources of DTI inaccuracy, which is limiting its clinical application.

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Section: Arcuate Fasciculus (Af)supporting

confidence: 67%

The usefulness and limitations of diffusion tensor imaging – a review study

Kierońska¹,

Słoniewski²

2020

Eur J Trans Clin Med

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“…1-9 The eloquent areas of the brain have been defined as the areas associated with critical neurological functions, such as language, sensory, motor, visual, cortical, and subcortical regions. 10-12 AC can also be performed for different lesions, ranging from primary tumors 13,14 and metastases 15,16 to epilepsy 17,18 and cavernomas. 19-21…”

mentioning

confidence: 99%

Stress, Anxiety, and Depression Associated With Awake Craniotomy: A Systematic Review

et al. 2022

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BACKGROUND: Awake craniotomy (AC) enables real-time monitoring of cortical and subcortical functions when lesions are in eloquent brain areas. AC patients are exposed to various preoperative, intraoperative, and postoperative stressors, which might affect their mental health. OBJECTIVE: To conduct a systematic review to better understand stress, anxiety, and depression in AC patients. METHODS: PubMed, Scopus, and Web of Science databases were searched from January 1, 2000, to April 20, 2022, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline. RESULTS: Four hundred forty-seven records were identified that fit our inclusion and exclusion criteria for screening. Overall, 24 articles consisting of 1450 patients from 13 countries were included. Sixteen studies (66.7%) were prospective, whereas 8 articles (33.3%) were retrospective. Studies evaluated stress, anxiety, and depression during different phases of AC. Twenty-two studies (91.7%) were conducted on adults, and 2 studies were on pediatrics (8.3 %). Glioma was the most common AC treatment with 615 patients (42.4%). Awake-awakeawake and asleep-awake-asleep were the most common protocols, each used in 4 studies, respectively (16.7%). Anxiety was the most common psychological outcome evaluated in 19 studies (79.2%). The visual analog scale and self-developed questionnaire by the authors (each n = 5, 20.8%) were the most frequently tools used. Twenty-three studies (95.8%) concluded that AC does not increase stress, anxiety, and/or depression in AC patients. One study (4.2%) identified younger age associated with panic attack. CONCLUSION: In experienced hands, AC does not cause an increase in stress, anxiety, and depression; however, the psychiatric impact of AC should not be underestimated.

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“…Emotional lability and alexithymia were also considered as possible exclusion criteria ( 32 , 38 , 48 , 57 , 65 ) as well as confusion, disorientation and developmental delay, due to the consequent inability to understand the surgical procedure and cooperate during it ( 25 , 35 , 37 , 57 , 66 ).…”

Section: Discussionmentioning

confidence: 99%

Indication and eligibility of glioma patients for awake surgery: A scoping review by a multidisciplinary perspective

et al. 2022

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BackgroundAwake surgery (AS) permits intraoperative mapping of cognitive and motor functions, allowing neurosurgeons to tailor the resection according to patient functional boundaries thus preserving long-term patient integrity and maximizing extent of resection. Given the increased risks of the awake scenario, the growing importance of AS in surgical practice favored the debate about patient selection concerning both indication and eligibility criteria. Nonetheless, a systematic investigation is lacking in the literature.ObjectiveTo provide a scoping review of the literature concerning indication and eligibility criteria for AS in patients with gliomas to answer the questions:1) "What are the functions mostly tested during AS protocols?" and 2) "When and why should a patient be excluded from AS?".Materials and methodsPertinent studies were retrieved from PubMed, PsycArticles and Cochrane Central Register of Controlled Trials (CENTRAL), published until April 2021 according to the PRISMA Statement Extension for Scoping Reviews. The retrieved abstracts were checked for the following features being clearly stated: 1) the population described as being composed of glioma(LGG or HGG) patients; 2) the paper had to declare which cognitive or sensorimotor function was tested, or 2bis)the decisional process of inclusion/exclusion for AS had to be described from at least one of the following perspectives: neurosurgical, neurophysiological, anesthesiologic and psychological/neuropsychological.ResultsOne hundred and seventy-eight studies stated the functions being tested on 8004 patients. Language is the main indication for AS, even if tasks and stimulation techniques changed over the years. It is followed by monitoring of sensorimotor and visuospatial pathways. This review demonstrated an increasing interest in addressing other superior cognitive functions, such as executive functions and emotions. Forty-five studies on 2645 glioma patients stated the inclusion/exclusion criteria for AS eligibility. Inability to cooperate due to psychological disorder(i.e. anxiety),severe language deficits and other medical conditions(i.e.cardiovascular diseases, obesity, etc.)are widely reported as exclusion criteria for AS. However, a very few papers gave scale exact cut-off. Likewise, age and tumor histology are not standardized parameters for patient selection.ConclusionGiven the broad spectrum of functions that might be safely and effectively monitored via AS, neurosurgeons and their teams should tailor intraoperative testing on patient needs and background as well as on tumor location and features. Whenever the aforementioned exclusion criteria are not fulfilled, AS should be strongly considered for glioma patients.

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Awake craniotomy without sedation in treatment of patients with lesional epilepsy

Cited by 14 publications

References 33 publications

The usefulness and limitations of diffusion tensor imaging – a review study

The usefulness and limitations of diffusion tensor imaging – a review study

Stress, Anxiety, and Depression Associated With Awake Craniotomy: A Systematic Review

Indication and eligibility of glioma patients for awake surgery: A scoping review by a multidisciplinary perspective

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