Awake craniotomy: indications, benefits, and techniques
Keywords:
Craniotomy, Intraoperative Awareness, Neurosurgery, Anesthesia, Monitoring, Physiologic
Abstract
Awake craniotomy is mainly used for mapping and resection of lesions in vitally important brain areas where imaging is not sufficiently sensitive. These are most commonly speech and motor areas. The awake approach has become increasingly popular with wider indications due to the advantage of better neurological and other perioperative outcomes including analge sia and postoperative nausea and vomiting. Improvements in anesthetic agents and techniques especially LMA have made a great contribution. Frequently used medications are propofol, dexmedetomidine, and remifentanil. Common anesthetic regi mens range from light-moderate sedation, deep sedation, or general anesthesia during the pre-mapping and postmapping phases. In all sedation-anesthesia techniques, the patients are awake and able to speak and/or move during the mapping phase. This approach to intracranial surgical procedure requires skill, experience, and commitment on the part of the entire OR team. This review, from the point of view of authors, discusses the indications and contraindications, benefits, anesthetic techni ques, challenges, and management, as well as potential future directions of awake craniotomy.
References
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29. Sokhal N, Rath GP, Chaturvedi A, et al. Anaesthesia for awake craniotomy: a retrospective study of 54 cases. Indian J Anaesth 2015;59:300-305.
30. Nossek E, Matot I, Shahar T, et al. Intraoperative seizures during awake craniotomy: incidence and consequences: analysis of 477 patients. Neurosurgery 2013;73:135-140.
31. Nossek E, Matot I, Shahar T, et al. Failed awake craniotomy: a retrospective analysis in 424 patients undergoing craniotomy for brain tumor. J Neurosurg 2013;118:243-249.
32. Flexman AM, Ng JL, Gelb AW. Acute and chronic pain following craniotomy. Curr Opin Anaesthesiol 2010;23:551-557.
33. Flexman AM, Meng L, Gelb AW. Outcomes in neuroanesthesia: what matters most? Can J Anaesth 2016;63:205-211.
34. Gruenbaum SE, Meng L, Bilotta F. Recent trends in the anesthetic management of craniotomy for supratentorial tumor resection. Curr Opin Anaesthesiol 2016;29:552-557.
35. Wigmore TJ, Mohammed K, Jhanji S. Long-term survival for patients undergoing volatile versus IV anesthesia for cancer surgery: a retrospective analysis. Anesthesiology 2016;124:69-79.
2. Sajonz BE, Amtage F, Reinacher PC, Jenkner C, Piroth T, Katzler J, Urbach H, Coenen VA. Deep Brain Stimulation for Tremor Tractographic Versus Traditional (DISTINCT): Study Protocol of a Randomized Controlled Feasibility Trial. JMIR Res Protoc 2016; 5:e244.
3. Hervey-Jumper SL, Berger MS. Maximizing safe resection of low-and high-grade glioma. J Neurooncol 2016;130:269-282.
4. Sommer B, Grummich P, Coras R, Kasper BS, Blumcke I, Hamer HM, Stefan H, Buchfelder M, Roessler K. Integration of functional neuronavigation and intraoperative MRI in surgery for drug-resistant extratemporal epilepsy close to eloquent brain areas. Neurosurg Focus 2013;34:E4.
5. Gabarros A, Young WL, McDermott MW, Lawton MT. Language and motor mapping during resection of brain arteriovenous malformations: indications, feasibility, and utility. Neurosurgery 2011;68:744-752.
6. Meng L, Weston SD, Chang EF, Gelb AW. Awake craniotomy in a patient with ejection fraction of 10%: considerations of cerebro-vascular and cardiovascular physiology. J Clinical Anesth 2015;27:256-261.
7. Meng L, Han SJ, Rollins MD, Gelb AW, Chang EF. Awake brain tumor resection during pregnancy: Decision making and technical nuances. J Clin Neurosci 2016;24:160-162.
8. Balogun JA, Khan OH, Taylor M, Dirks P, Der T, Carter Snead Iii O, et al. Pediatric awake craniotomy and intra-operative stimulation mapping. J Clin Neurosci 2014;21:1891-1894.
9. Hervey-Jumper SL, Li J, Lau D, Molinaro AM, Perry DW, Meng L, Berger MS. Awake craniotomy to maximize glioma resection: methods and technical nuances over a 27-year period. J Neurosurg 2015;123:325-339.
10. Dziedzic T, Bernstein M. Awake craniotomy for brain tumor: indications, technique and benefits. Expert Rev Neurother 2014;14:1405-1415.
11. Brown T, Shah AH, Bregy A, et al. Awake craniotomy for brain tumor resection: the rule rather than the exception? J Neurosurg Anesthesiol 2013;25:240-247.
12. Hervey-Jumper SL, Berger MS. Technical nuances of awake brain tumor surgery and the role of maximum safe resection. J Neurosurg Sci 2015;59:351-360.
13. Groshev A, Padalia D, Patel S, et al. Clinical outcomes from maximum-safe resection of primary and metastatic brain tumors using awake craniotomy. Clin Neurol Neurosurg 2017;157:25-30.
14. Beez T, Boge K, Wager M, et al. Tolerance of awake surgery for glioma: a prospective European Low Grade Glioma Network multicenter study. Acta Neurochir 2013;155:1301-1308.
15. Milian M, Tatagiba M, Feigl GC. Patient response to awake craniotomy-a summary overview. Acta Neurochir 2014;156: 1063-1070.
16. Meng L, Berger MS, Gelb AW. The potential benefits of awake craniotomy for brain tumor resection: an anesthesiologist’s perspective. J Neurosurg Anesthesiol 2015;27:310-317.
17. Howe KL, Zhou G, July J, et al. Teaching and sustainably implementing awake craniotomy in resource-poor settings. World Neurosurg 2013;80:e171-e174.
18. Conte V, L’Acqua C, Rotelli S, et al. Bispectral index during asleep-awake craniotomies. J Neurosurg Anesthesiol 2013;25:279-284.
19. Rajan S, Cata JP, Nada E, et al. Asleep-awake-asleep craniotomy: a comparison with general anesthesia for resection of supratentorial tumors. J Clin Neurosci 2013;20:1068-1073.
20. Lin N, Han R, Zhou J, et al. Mild sedation exacerbates or unmasks focal neurologic dysfunction in neurosurgical patients with supratentorial brain mass lesions in a drug-specific manner. Anesthesiology 2016;124:598-607.
21. Kulikov AS, Kobyakov GL, Gavrilov AG, et al. Awake craniotomy: analysis of complicated cases. Zh Vopr Neirokhir ImNNBurdenko 2015;79:15-21.
22. Sivasankar C, Schlichter RA, Baranov D, et al. Awake craniotomy: a new airway approach. Anesth Analg 2016;122:509-511.
23. Deras P, Moulinie G, Maldonado IL, et al. Intermittent general anesthesia with controlled ventilation for asleep-awake-asleep brain surgery: a prospective series of 140 gliomas in eloquent areas. Neurosurgery 2012;71:764-771.
24. Potters JW, Klimek M. Awake craniotomy: improving the patient's experience. Curr Opin Anaesthesiol 2015;28:511-516.
25. Breshears JD, Molinaro AM, Chang EF. A probabilistic map of the human ventral sensorimotor cortex using electrical stimulation. J Neurosurg 2015;123:340-349.
26. Roux FE, Miskin K, Durand JB, et al. Electrostimulation mapping of comprehension of auditory and visual words. Cortex 2015;71:398-408.
27. Gras-Combe G, Moritz-Gasser S, Herbet G, et al. Intraoperative subcortical electrical mapping of optic radiations in awake surgery for glioma involving visual pathways. J Neurosurg 2012;117:466-473.
28. Talacchi A, Santini B, Casartelli M, et al. Awake surgery between art and science. Part II: Language and cognitive mapping. Funct Neurol 2013;28:223-239.
29. Sokhal N, Rath GP, Chaturvedi A, et al. Anaesthesia for awake craniotomy: a retrospective study of 54 cases. Indian J Anaesth 2015;59:300-305.
30. Nossek E, Matot I, Shahar T, et al. Intraoperative seizures during awake craniotomy: incidence and consequences: analysis of 477 patients. Neurosurgery 2013;73:135-140.
31. Nossek E, Matot I, Shahar T, et al. Failed awake craniotomy: a retrospective analysis in 424 patients undergoing craniotomy for brain tumor. J Neurosurg 2013;118:243-249.
32. Flexman AM, Ng JL, Gelb AW. Acute and chronic pain following craniotomy. Curr Opin Anaesthesiol 2010;23:551-557.
33. Flexman AM, Meng L, Gelb AW. Outcomes in neuroanesthesia: what matters most? Can J Anaesth 2016;63:205-211.
34. Gruenbaum SE, Meng L, Bilotta F. Recent trends in the anesthetic management of craniotomy for supratentorial tumor resection. Curr Opin Anaesthesiol 2016;29:552-557.
35. Wigmore TJ, Mohammed K, Jhanji S. Long-term survival for patients undergoing volatile versus IV anesthesia for cancer surgery: a retrospective analysis. Anesthesiology 2016;124:69-79.
How to Cite
1.
Zhang K, Gelb AW. Awake craniotomy: indications, benefits, and techniques. Colomb. J. Anesthesiol. [Internet]. 2018 Dec. 1 [cited 2024 Apr. 28];46(Supplement):46-51. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/136
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Published
2018-12-01
How to Cite
1.
Zhang K, Gelb AW. Awake craniotomy: indications, benefits, and techniques. Colomb. J. Anesthesiol. [Internet]. 2018 Dec. 1 [cited 2024 Apr. 28];46(Supplement):46-51. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/136
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