Investigation of Asleep versus Awake Motor Mapping in Resective Brain Surgery

Murcia, Derrick; D’Souza, Shawn; Abozeid, Mohab; Thompson, John A.; Djoyum, Teguo Daniel; Ormond, D. Ryan

doi:10.1016/j.wneu.2021.09.119

Cited by 6 publications

(5 citation statements)

References 24 publications

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“…According to a European Low-Grade Glioma Network survey [6], eighteen centers (90%) preferably used either MAC or AAA; only three centers reported AAA and MAC simultaneously [12][13][14]. In fact, there were few studies comparing the advantages or disadvantages of these two anesthetic techniques [13][14][15][16][17], especially when multiple monitoring was in use. A meta-analysis only made comparisons among AC failures, conversion to GA, intraoperative seizures, and neurological dysfunction, but those data was [14] concluded that the AAA technique may provide better results with respect to agitation and seizure, and another study [13] suggested a similar perioperative outcome between the two techniques, with shorter operative time for MAC, and the third study demonstrated that MCA with sole dexmedetomidine reduces respiratory and cardiovascular adverse events with a low need for antihypertensive and vasoactive drugs, probably ensuring more rapid surgery and reducing length of hospitalization [12].…”

Section: Discussionmentioning

confidence: 99%

Monitored anesthesia care and asleep-awake-asleep techniques combined with multiple monitoring for resection of gliomas in eloquent brain areas: a retrospective analysis of 225 patients

et al. 2022

Chin Neurosurg Jl

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Background Awake craniotomy (AC) has become gold standard in surgical resection of gliomas located in eloquent areas. The conscious sedation techniques in AC include both monitored anesthesia care (MAC) and asleep-awake-asleep (AAA). The choice of optimal anesthetic method depends on the preferences of the surgical team (mainly anesthesiologist and neurosurgeon). The aim of this study was to compare the difference in physiological and blood gas data, dosage of different drugs, the probability of switching to endotracheal intubation, and extent of tumor resection and dysfunction after operation between AAA and MAC anesthetic management for resection of gliomas in eloquent brain areas. Methods Two-hundred and twenty-five patients with super-tentorial tumor located in eloquent areas underwent AC from 2009 to 2021 in Xijing Hospital. Forty-one patients underwent AAA technique, and the rest one-hundred eighty-four patients underwent MAC technique. Anesthetic management, dosage of different drugs, intraoperative complications, postoperative outcomes, adverse events, extent of resection and motor, and sensory and language dysfunction after operation were compared between MAC and AAA. Result There was no significant difference in gender, KPS score, MMSE score, glioma grade, type, and growth site between the patients in the two groups, except the older age of patients in MAC group than that in AAA group. During the whole process of operation, there were greater pulse pressure difference (P = 0.046), shorter operation time (P = 0.039), less dosage of remifentanil (P = 0.000), more dosage of dexmedetomidine (P = 0.013), more use of antiemetics (81%, P = 0.0067), lower use of vasoactive agent (45.1%, P = 0.010), and lower probability of conversion to general anesthesia (GA, P = 0.027) in MAC group than that in AAA group. Blood gas analysis showed that PetCO2 (P = 0.000), Glu concentration (P = 0.000), and PaCO2 (P = 0.000) were higher, but SPO2 (P = 0.002) and PaO2 (P = 0.000) were lower in MAC group than that in AAA group. In the postoperative recovery stage, compared with that of AAA group, the probability of dysfunction in MAC group at 1, 3, 5, and 7 days after operation was lower, which were 27.8% vs 53.6% (P = 0.003), 31% vs 68.3% (P = 0.000), 28.8% vs 63.4% (P = 0.000), and 25.6% vs 58.5% (P = 0.000), respectively. Conclusion Compared with AAA, it seems that MAC has more advantages in the management for resection of gliomas in eloquent brain areas, and MAC combined with multiple monitoring such as cerebral cortical mapping, neuronavigation, and ultrasonic detection is worthy of popularization for the resection of gliomas in eloquent brain areas.

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Section: Discussionmentioning

confidence: 99%

Monitored anesthesia care and asleep-awake-asleep techniques combined with multiple monitoring for resection of gliomas in eloquent brain areas: a retrospective analysis of 225 patients

et al. 2022

Chin Neurosurg Jl

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“…77,78 Since the introduction of the HF paradigm for direct cortical motor mapping by Taniguchi et al in 1993, 9 more resections involving perirolandic tumors have been performed under GA with comparable outcomes to AC. 79,80 However, Rossi et al reported that a significant portion of patients undergoing glioma resection under GA developed hand apraxia after surgery. 81 This led to the development of more advanced motor tasks that can be evaluated during AC.…”

Section: Motor Mappingmentioning

confidence: 99%

Intraoperative Stimulation Mapping in Neurosurgery for Anesthesiologists—Part 1: The Technical Nuances

Masohood,

Paquin-Lanthier,

Chui

et al. 2023

J Neuroanaesth Crit Care

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Brain mapping has evolved tremendously in the past decade, fueled by advances in functional neuroimaging technology in neuro-oncology and epilepsy surgery. Despite this, wide anatomic-functional interindividual variability and intraoperative brain shift continue to challenge neurosurgeons performing surgery within or near eloquent brain regions. As such, intraoperative direct cortical and subcortical stimulation mapping remains the gold standard for localizing eloquent brain regions with precision for a safe and tailored resection. Intraoperative stimulation mapping (ISM) allows for maximizing the extent of resection while minimizing postoperative neurological deficits, resulting in better patient outcomes. Understanding the technical nuances of ISM is imperative for the anesthesiologist to provide better anesthetic management tailored to the surgery and stimulation mapping planned. A comprehensive search was performed on electronic databases to identify articles describing intraoperative cortical and subcortical mapping, language, and motor mapping. In the first part of this narrative review, we summarize the salient technical aspects of ISM and the common neurophysiological tasks assessed intraoperatively relevant to the anesthesiologist.

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“…Most recent studies on motor mapping under GA reported using a TIVA protocol, usually consisting of propofol and remifentanil infusions with muscle relaxants avoided after intubation. [29][30][31][32][33][34] TIVA is recommended as the optimal anesthetic regime in the literature 35 because of the well-recognized dose-dependent effects of volatile anesthetics on transcranial MEP (tcMEP) amplitudes, [36][37][38][39] which many authors postulate to elicit similar effects during direct cortical stimulation of MEP. Low doses of volatile agents (Minimum Alveolar Concentration < 0.5) allow acceptable tcMEP recordings for clinical interpretation in some patients.…”

Section: Anesthesia Considerations For Motor Mapping Under General An...mentioning

confidence: 99%

Intraoperative Stimulation Mapping in Neurosurgery for Anesthesiologists, Part 2: The Anesthetic Considerations

Masohood,

Paquin-Lanthier,

Chui

et al. 2023

J Neuroanaesth Crit Care

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Intraoperative language and sensorimotor function mapping with direct electrical stimulation allows precise identification of functionally important brain regions. Direct electrical stimulation brain mapping has become the standard of care for the resection of brain lesions near or within eloquent regions with various patient outcome benefits. Intraoperative stimulation mapping (ISM) is commonly performed in an awake patient for language and motor assessments. However, motor mapping under general anesthesia, termed asleep motor mapping, has been increasingly performed over the last two decades for lesions primarily affecting the motor areas of the brain. Both asleep-awake-asleep and monitored anesthesia care have been successfully used for awake craniotomy in modern neuroanesthesia. Each anesthetic agent exerts varying effects on the quality of ISM, especially under general anesthesia. Careful selection of an anesthetic technique is crucial for the successful performance of ISM in both awake and asleep conditions. A comprehensive search was performed on electronic databases such as PubMed, Embase, Cochrane, Scopus, Web of Science, and Google Scholar to identify articles describing anesthesia for awake craniotomy, intraoperative brain mapping, and asleep motor mapping. In the second part of this narrative review, we summarize the effects of different anesthetic regimes and agents on ISM, causes of the failure of awake craniotomy and mapping, and outline the anesthetic considerations for ISM during awake craniotomy and asleep motor mapping.

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Investigation of Asleep versus Awake Motor Mapping in Resective Brain Surgery

Cited by 6 publications

References 24 publications

Monitored anesthesia care and asleep-awake-asleep techniques combined with multiple monitoring for resection of gliomas in eloquent brain areas: a retrospective analysis of 225 patients

Monitored anesthesia care and asleep-awake-asleep techniques combined with multiple monitoring for resection of gliomas in eloquent brain areas: a retrospective analysis of 225 patients

Intraoperative Stimulation Mapping in Neurosurgery for Anesthesiologists—Part 1: The Technical Nuances

Intraoperative Stimulation Mapping in Neurosurgery for Anesthesiologists, Part 2: The Anesthetic Considerations

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