scholarly journals Using cortical function mapping by awake craniotomy dealing with the patient with recurrent glioma in the eloquent cortex

2020 ◽  
Author(s):  
Ying-Ching Li ◽  
Hsiao-Yean Chiu ◽  
Kuo-Chen Wei ◽  
Ya-Jui Lin ◽  
Ko-Ting Chen ◽  
...  
Keyword(s):  
Awake Craniotomy ◽  
Recurrent Glioma ◽  
Cortical Function ◽  
Eloquent Cortex ◽  
Function Mapping

Factors associated with somnolence during brain function mapping in awake craniotomy

2021 ◽  
Author(s):  
Toshiyuki Mizota ◽  
Miho Hamada ◽  
Atsuko Shiraki ◽  
Takayuki Kikuchi ◽  
Yohei Mineharu ◽  
...  
Keyword(s):  
Brain Function ◽  
Awake Craniotomy ◽  
Factors Associated ◽  
Function Mapping

scholarly journals Development and implementation of a novel child life protocol to enhance psychosocial support for pediatric awake craniotomies: technical note

2020 ◽  
Vol 48 (2) ◽  
pp. E5
Author(s):  
Michael M. McDowell ◽  
Daniela Ortega Peraza ◽  
Taylor J. Abel
Keyword(s):  
Prospective Studies ◽  
Positive Reinforcement ◽  
Psychosocial Support ◽  
Patient Experiences ◽  
Technical Note ◽  
Awake Craniotomy ◽  
Child Life ◽  
Child Life Specialist ◽  
Patient Tolerance ◽  
Eloquent Cortex

Awake craniotomies are a crucial tool for identifying eloquent cortex, but significant limitations frequently related to patient tolerance have limited their applicability in pediatric cases. The authors describe a comprehensive, longitudinal protocol developed in collaboration with a certified child life specialist (CCLS) in order to enhance patient experiences and develop resiliency related to the intraoperative portion of cases. This protocol includes preoperative conditioning, intraoperative support, and postoperative positive reinforcement and debriefing. A unique coping plan is developed for each prospective patient. With appropriate support, awake craniotomy may be applicable in a wider array of preadolescent and adolescent patients than has previously been possible. Future prospective studies are needed to validate this approach.

scholarly journals The Merits of Awake Craniotomy for Glioblastoma in the Left Hemispheric Eloquent Area: One Institution Experience

2020 ◽  
Author(s):  
Ying-Ching Li ◽  
Hsiao-Yean Chiu ◽  
Ya-Jui Lin ◽  
Ko-Ting Chen ◽  
Peng-Wei Hsu ◽  
...  
Keyword(s):  
Progression Free Survival ◽  
Extent Of Resection ◽  
Awake Craniotomy ◽  
Treatment Center ◽  
Low Grade ◽  
Karnofsky Performance Score ◽  
Free Survival ◽  
Neurological Outcomes ◽  
Eloquent Cortex ◽  
The Mean

Abstract Background Awake craniotomy (AC) with intraoperative stimulation mapping is the standard treatment for gliomas, especially those on the eloquent cortex. Many studies have reported survival benefits with the use of AC in patients with glioma, however most of these studies have focused on low-grade glioma. The aim of this study was to evaluate the experience of one treatment center over 10 years for resection of left hemispheric eloquent glioblastoma. Methods This retrospective analysis included 48 patients with left hemispheric eloquent glioblastoma who underwent AC and 61 patients who underwent surgery under general anesthesia (GA) between 2008 and 2018. Perioperative risk factors, extent of resection (EOR), preoperative and postoperative Karnofsky Performance Score (KPS), progression-free survival (PFS) and overall survival (OS) were assessed. Results The postoperative KPS was significantly lower in the GA patients compared to the AC patients (p=0.002). The EOR in the GA group was 90.2% compared to 94.9% in the AC group (p=0.003). The mean PFS was 18.9 months in the GA group and 23.2 months in the AC group (p=0.001). The mean OS was 25.5 months in all patients, 23.4 months in the GA group, and 28.1 months in the AC group (p<0.001). In multivariate analysis, the EOR and preoperative KPSindependently predicted better OS. Conclusion The patients with left hemispheric eloquent glioblastoma in this study had better neurological outcomes, maximal tumor removal, and better PFS and OS after AC than surgery under GA. Awake craniotomy should be performed in these patients if the resources are available.

scholarly journals Awake Craniotomy vs Craniotomy Under General Anesthesia for Eloquent Glioma: Postoperative General Functional Preservation

2019 ◽  
Author(s):  
Ying-Ching Li ◽  
Hsiao-Yean Chiu ◽  
Ya-Jui Lin ◽  
Ko-Ting Chen ◽  
Peng-Wei Hsu ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Functional Status ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Eastern Cooperative Oncology Group ◽  
Tumor Resection ◽  
Awake Craniotomy ◽  
Newly Diagnosed ◽  
Eloquent Cortex ◽  
Functional Preservation

Abstract Background Awake craniotomy (AC) with intraoperative stimulation mapping is the standard treatment for glioma, especially when present on the eloquent cortex. The purpose of this study was to investigate whether functional preservation after AC compromises patient survival as compared with craniotomy under general anesthesia (GA). Methods The medical records of 339 patients who underwent tumor resection surgery for gliomas from January 2010 to December 2014 were retrospectively reviewed. Among these patients, 62 underwent AC with intraoperative stimulation mapping. The primary outcome was the Eastern cooperative oncology group (ECOG) performance score at 3 months postoperatively. Secondary outcomes were the progression-free survival (PFS) and overall survival (OS). A generalized linear model and the Cox proportional hazard model were used to evaluate potential factors influencing general functional status and progression-free survival.Results The newly-diagnosed disease AC and repeat-surgery groups were comparable in terms of sex, age, pathologic grade, extent of resection (EOR) and preoperative Karnofsky Performance Status (KPS). Among the patients with newly-diagnosed disease, the postoperative ECOG score of the AC group was significantly better than that of the GA group. Pathologic grade and the EOR determined the PFS and OS in both the AC and GA groups.Conclusion AC with intraoperative stimulation mapping is safe and allows maximal removal of lesions around the eloquent cortex. Greater preservation of neurologic function may have resulted in a better postoperative general functional status in the AC group.

Challenges in Awake Craniotomy for Intrinsic Brain Tumors in Eloquent Cortex

2017 ◽  
Vol 2 (5) ◽  
Keyword(s):  
Brain Tumors ◽  
Neurological Deficit ◽  
Tumor Resection ◽  
Preoperative Assessment ◽  
Awake Craniotomy ◽  
Low Grade ◽  
Tumor Removal ◽  
Unique Challenge ◽  
Progressive Neurological Deficit ◽  
Eloquent Cortex

Introduction: Surgical treatment of brain tumors in the eloquent areas has high risk of functional impairment like speech or motor. These tumors represent a unique challenge as most of the patients have a higher risk of treatment related complications. A wake craniotomy is a useful surgical approach to help to identify and preserve functional areas in the brain and maximizes tumor removal and minimizes complications. Methods: Selected patients admitted with intrinsic brain tumor between from July, 2011 to August, 2016 in the eloquent area of brain like speech or motor area were chosen for awake craniotomy. A retrospective analysis was done. A preoperative assessment was also done. These patients were presented with seizure and or progressive neurological deficit like speech or motor. A standard anesthesia monitoring was done during surgery. Long acting local anesthesia (Bupivacaine) was used for scalp block. The surgeries were performed in a state of asleep-awake-asleep pattern, keeping the patients fully awake during tumor removal. Propofol and Fentanyl was used as anesthetic agents which was completely withdrawn prior to tumor removal. The speech and motor functions were closely monitored clinically by verbal commands during tumor resection. No brain mapping was performed due to lack of resources. All patients underwent noncontrast computed tomogram head in the first post-operative day. Results: A total of 35 patients were included in the study. The oldest patient was 55 years and youngest being 24 years (mean 36 years). 20 (57.14 %) were females and 15(42.85 %) males. 20 (57.14%) patients presented with predominantly seizure disorders and rest with progressive neurological deficit like speech or motor. 30 (85.71%) patients were discharged on second post-operative day. Complications were encountered in 4 (11.42 %) patients who developed brain swelling intraoperatively and 5(14.28 %) deteriorated neurologically in the immediate post-operative period however managed successfully and discharged in a week’s time. 5(14.28%) patients require ICU/ HDU care for different reasons. There was no mortality during the hospital stay. Histopathology revealed 25 (71.42 %) patients as low grade glioma, 8 (22.85%) as high grade glioma and 2 (5.71%) of them were metastases. Conclusion: A wake Craniotomy is a safe surgical management for intrinsic brain tumors in the eloquent cortex although surgery and anesthesia is a challenge. It offers great advantage towards disease outcome. However long follow up and more studies are required.

Prospective study of awake craniotomy used routinely and nonselectively for supratentorial tumors

2007 ◽  
Vol 107 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Demitre Serletis ◽  
Mark Bernstein
Keyword(s):  
General Anesthesia ◽  
Brain Mapping ◽  
Tumor Resection ◽  
Tumor Location ◽  
Awake Craniotomy ◽  
Neurological Deficits ◽  
Wound Complications ◽  
Presenting Symptoms ◽  
Eloquent Cortex ◽  
Supratentorial Tumors

Object The authors prospectively assessed the value of awake craniotomy used nonselectively in patients undergoing resection of supratentorial tumors. Methods The demographic features, presenting symptoms, tumor location, histological diagnosis, outcomes, and complications were documented for 610 patients who underwent awake craniotomy for supratentorial tumor resection. Intraoperative brain mapping was used in 511 cases (83.8%). Mapping identified eloquent cortex in 115 patients (22.5%) and no eloquent cortex in 396 patients (77.5%). Results Neurological deficits occurred in 89 patients (14.6%). In the subset of 511 patients in whom brain mapping was performed, 78 (15.3%) experienced postoperative neurological worsening. This phenomenon was more common in patients with preoperative neurological deficits or in those individuals in whom mapping successfully identified eloquent tissue. Twenty-five (4.9%) of the 511 patients suffered intraoperative seizures, and two of these individuals required intubation and induction of general anesthesia after generalized seizures occurred. Four (0.7%) of the 610 patients developed wound complications. Postoperative hematomas developed in seven patients (1.1%), four of whom urgently required a repeated craniotomy to allow evacuation of the clot. Two patients (0.3%) required readmission to the hospital soon after being discharged. There were three deaths (0.5%). Conclusions Awake craniotomy is safe, practical, and effective during resection of supratentorial lesions of diverse pathological range and location. It allows for intraoperative brain mapping that helps identify and protect functional cortex. It also avoids the complications inherent in the induction of general anesthesia. Awake craniotomy provides an excellent alternative to surgery of supratentorial brain lesions in patients in whom general anesthesia has been induced.

Outcome of fully awake craniotomy for lesions near the eloquent cortex: analysis of a prospective surgical series of 79 supratentorial primary brain tumors with long follow-up

2009 ◽  
Vol 151 (10) ◽  
pp. 1215-1230 ◽  
Author(s):  
Luiz Claudio Modesto Pereira ◽  
Karina M. Oliveira ◽  
Gisele L. L‘ Abbate ◽  
Ricardo Sugai ◽  
Joines A. Ferreira ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Awake Craniotomy ◽  
Primary Brain Tumors ◽  
Eloquent Cortex

scholarly journals The First Awake Craniotomy for Eloquent Glioblastoma in Southern Thailand

2019 ◽  
Author(s):  
Anukoon Kaewborisutsakul ◽  
Sakchai Sae-Heng ◽  
Chanatthee Kitsiripant ◽  
Pannawit Benjhawaleemas
Keyword(s):  
Brain Area ◽  
Oncologic Outcome ◽  
Patient Care Team ◽  
Awake Craniotomy ◽  
Functional Brain Mapping ◽  
Southern Thailand ◽  
Technical Details ◽  
Eloquent Cortex ◽  
Surgical Aspects ◽  
First Time

Awake craniotomy (AC) with direct cortical stimulation is becoming the gold standard for functional brain mapping. It is used to identify the safe brain area before pathologic resection. This method indicates the pathology near or at the eloquent cortex, such as gliomas or metastasis. AC can optimize the patient’s quality of life and oncologic outcome. This task requires the active cooperation of a patient care team familiar with advanced neuroscience and challenging to learn. We report the first time this operation which performed in our institute with technical details, in terms of anesthesia, and surgical aspects.

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