Sensations of patients and their satisfaction during awake craniotomy

Lubnin, А. Yu.; Sinbukhova, Elena; Kulikov, A S; Kobyakov, G L

doi:10.17116/neiro20208405189

Vopr. neirokhir.

2020

DOI: 10.17116/neiro20208405189

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Sensations of patients and their satisfaction during awake craniotomy

А. Yu. Lubnin¹,

Elena Sinbukhova²,

A S Kulikov³

et al.

Abstract: Резюме Методика краниотомии в сознании (КС) за последние годы приобрела фантастическую распространенность и теперь уже не является уделом только высокоспециализированных нейрохирургических центров. Методологическая сторона КС разработана достаточно полно, чего нельзя сказать о таком аспекте, как исследование ощущений оперируемых пациентов и их общей удовлетворенност и. Анализу этой стороны проблемы и посвящен приводимый обзор литературы, в котором показано, что процедура КС положительно оценивается подавляющим… Show more

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Cited by 3 publications

References 61 publications

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Awake surgery in neurooncology. Part 1. Anesthesia features, selection of patients, method’s advantages and drawbacks

Dmitriev,

Sinkin,

Solodov

et al. 2024

Nejrohirurgiâ (Mosk.)

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To reduce patient’s discomfort during awake surgery convenient patient’s position on operation table is applied, comfort temperature and close contact to psychologist are supported. Anesthesiologic features of awake surgery include regional and conduction anesthesia of scalp nerves, light sedation, attentive control over air ways and dural infiltration with anesthetics. Keeping patient’s consciousness during surgical approach increases reliability of intraoperative tests but demands more thorough anesthesia and control over patient’s condition.Neuromonitoring in awake patient increases extent of gliomas’ resection and decreases risk of permanent neurological disorders.Risks of awake surgery are devided into respiratory, neurological, cardiological and psychological. Intraoperative seizures arise in 3–12 % of cases.Most of the patients rate awake surgery positively and agree to repeated similar operations.

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Awake surgery in neurooncology. Part 1. Anesthesia features, selection of patients, method’s advantages and drawbacks

Dmitriev,

Sinkin,

Solodov

et al. 2024

Nejrohirurgiâ (Mosk.)

View full text Add to dashboard Cite

show abstract

Awake surgery in neurooncology. Part 2. Functional intraoperative mapping

Dmitriev,

Sinkin,

Skalnaya

et al. 2024

Nejrohirurgiâ (Mosk.)

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Awake surgery is usually used to save patient’s speech. Various tests are applied for this purpose, whish selection depends on tumor location. In multilingual patients verbal centers usually have different position. Location of each of them is necessary to keep patient’s communication capabilities after operation.To study vision, tests with presentations of color points or pictures on the screen divided on 4 parts are used. Such testing allows to estimate vision and speech simultaneously.Mapping of motor area in awake patients allows to evaluate this function more comprehensively including motion planning, proprioceptive control and balance. Stimulation of sensory area in awake patients gives opportunity to differ various types of sensitivity.Mapping and keeping of cognitive functions, memory, attention and ability of calculation increases chance to save professional skills and quality of life after operation.

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5-ALA-guided tumor resection during awake speech mapping in gliomas located in eloquent speech areas: Single-center experience

et al. 2022

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BackgroundAchieving maximal functionally safe resection of gliomas located within the eloquent speech areas is challenging, and there is a lack of literature on the combined use of 5-aminolevulinic acid (5-ALA) guidance and awake craniotomy.ObjectiveThe aim of this study was to describe our experience with the simultaneous use of 5-ALA fluorescence and awake speech mapping in patients with left frontal gliomas located within the vicinity of eloquent speech areas.Materials and methodsA prospectively collected database of patients was reviewed. 5-ALA was administered at a dose of 20 mg/kg 2 h prior to operation, and an operating microscope in BLUE400 mode was used to visualize fluorescence. All patients underwent surgery using the “asleep–awake–asleep” protocol with monopolar and bipolar electrical stimulation to identify the proximity of eloquent cortex and white matter tracts and to guide safe limits of resection along with fluorescence guidance. Speech function was assessed by a trained neuropsychologist before, during, and after surgery.ResultsIn 28 patients operated with cortical mapping and 5-ALA guidance (12 Grade 4, 6 Grade 3, and 10 Grade 2 gliomas), Broca’s area was identified in 23 cases and Wernicke’s area was identified in 5 cases. Fluorescence was present in 14 cases. Six tumors had residual fluorescence due to the positive speech mapping in the tumor bed. Transient aphasia developed in 14 patients, and permanent aphasia developed in 4 patients. In 6 patients operated with cortical and subcortical speech mapping and 5-ALA guidance (4 Grade 4, 1 Grade 3, and 1 Grade 2 gliomas), cortical speech areas were mapped in 5 patients and subcortical tracts were encountered in all cases. In all cases, resection was stopped despite the presence of residual fluorescence due to speech mapping findings. Transient aphasia developed in 6 patients and permanent aphasia developed in 4 patients. In patients with Grade 2–3 gliomas, targeted biopsy of focal fluorescence areas led to upgrading the grade and thus more accurate diagnosis.Conclusion5-ALA guidance during awake speech mapping is useful in augmenting the extent of resection for infiltrative high-grade gliomas and identifying foci of anaplasia in non-enhancing gliomas, while maintaining safe limits of functional resection based on speech mapping. Positive 5-ALA fluorescence in diffuse Grade 2 gliomas may be predictive of a more aggressive disease course.

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Sensations of patients and their satisfaction during awake craniotomy

Cited by 3 publications

References 61 publications

Awake surgery in neurooncology. Part 1. Anesthesia features, selection of patients, method’s advantages and drawbacks

Awake surgery in neurooncology. Part 1. Anesthesia features, selection of patients, method’s advantages and drawbacks

Awake surgery in neurooncology. Part 2. Functional intraoperative mapping

5-ALA-guided tumor resection during awake speech mapping in gliomas located in eloquent speech areas: Single-center experience

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