Preoperative Prediction of Communication Difficulties during Awake Craniotomy in Glioma Patients: A Retrospective Evaluation of 136 Cases at a Single Institution

Kuribara, Tomoyoshi; Akiyama, Yukinori; Mikami, Takeshi; Kimura, Yusuke; Komatsu, Katsuya; Enatsu, Rei; Tokinaga, Yasuyuki; Mikuni, Nobuhiro

doi:10.2176/nmc.oa.2020-0232

Cited by 7 publications

(7 citation statements)

References 33 publications

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“…The lack of preoperative seizures and left-sided lesions were identified as risk factors for inappropriately awake condition. 13 ) On the basis of these results, preoperative conditions are important to select patients for awake craniotomy.…”

Section: Discussionmentioning

confidence: 99%

A Nationwide Questionnaire Survey on Awake Craniotomy in Japan

Kawata

Fukui

Mineharu

et al. 2022

Neurol. Med. Chir.(Tokyo)

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The number of awake craniotomies is increasing because of its beneficial features. However, not enough information is available regarding the current status of awake craniotomy in Japan. To evaluate the current status of awake craniotomy in institutes, a nationwide questionnaire survey was conducted. From June to August 2019, we conducted a questionnaire survey on awake craniotomy in the neurosurgery department of 45 institutes that perform awake craniotomies in Japan. Responses were obtained from 39 institutes (response rate, 86.7%). The main methods of awake craniotomy were almost the same in all institutes. Twenty-six institutes (66.7%) had fewer than 10 awake craniotomies (low-volume institutes) per year, and 13 high-volume institutes (33.3%) performed more than 10 awake craniotomies annually. Some institutes experienced a relatively high frequency of adverse events. In 11 institutes (28.2%), the frequency of intraoperative seizures was more than 10%. An intraoperative seizure frequency of 1%-9%, 10%-29%, and over 30% was identified in 12 (92%), 0 (0%), and 1 (8%) of the high-volume institutes, which was significantly less than in 16 (62%), 10 (38%), and 0 (0%) of the low-volume institutes (p = 0.0059). The routine usage of preoperative antiepileptic drugs was not different between them, but the old type was used more often in the low-volume institutes (p = 0.0022). Taken together, the annual number of awake craniotomies was less than 10 in over two-thirds of the institutes. Fewer intraoperative seizures were reported in the high-volume institutes, which tend not to preoperatively use the old type of antiepileptic drugs.

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Section: Discussionmentioning

confidence: 99%

A Nationwide Questionnaire Survey on Awake Craniotomy in Japan

Kawata

Fukui

Mineharu

et al. 2022

Neurol. Med. Chir.(Tokyo)

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“…Cooperation and active participation of the patient are the most important factors for a successful procedure ( 29 ). Therefore, one of the most cited exclusion criteria is the impossibility for the patient to positively cooperate with the surgical team: during AS, non-compliant behavior may cause significant and severe complications which may at least determine the abortion of the awake phase.…”

Section: Discussionmentioning

confidence: 99%

“…Age was widely considered as a possible exclusion criterion, even if standardization is lacking: lots of works described AS for patients older than 60 ( 6 , 13 , 25 – 27 , 34 , 38 , 41 , 42 , 45 , 46 , 49 , 60 ) or than 70 years of age ( 33 , 35 , 39 , 47 , 53 , 56 , 58 , 61 , 64 – 66 , 96 ). In some cases, also elderly people were awakened ( 29 , 31 , 39 , 40 , 48 , 52 ). On the other hand, considering the pediatric population (< 18 years old), several works adopted AS for children and adolescents ( 6 , 24 , 25 , 29 , 32 , 33 , 39 , 43 , 48 , 50 , 52 ).…”

Section: Discussionmentioning

confidence: 99%

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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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“…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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Preoperative Prediction of Communication Difficulties during Awake Craniotomy in Glioma Patients: A Retrospective Evaluation of 136 Cases at a Single Institution

Cited by 7 publications

References 33 publications

A Nationwide Questionnaire Survey on Awake Craniotomy in Japan

A Nationwide Questionnaire Survey on Awake Craniotomy in Japan

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

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

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