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.

JS01.4.A The neurocognitive function changes with awake craniotomy for low-grade glioma in the left hemispheric eloquent regions

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii5-ii5
Author(s):  
Y Wang ◽  
P Ji ◽  
S Guo ◽  
J Liu ◽  
Y Zhai ◽  
...  
Keyword(s):  
Cognitive Performance ◽  
Brain Mapping ◽  
Treatment Strategy ◽  
Cognitive Assessment ◽  
Tumor Resection ◽  
Tumor Location ◽  
Low Grade Glioma ◽  
Awake Craniotomy ◽  
Low Grade ◽  
Eloquent Area

Abstract BACKGROUND Cognitive deficit was frequently observed in glioma patients, especially for those on the eloquent area. Considering the increased life expectancy, brain mapping during awake craniotomy was preferentially applied to exacerbate neurocognitive deficits. The aim of the current study was to evaluate the neurocognitive changes during the perioperative period of resection of low-grade glioma (LGG) in the left side eloquent area with awake craniotomy in a major neurosurgical center in China for 5 years. MATERIAL AND METHODS We retrospectively analyzed patients with left-sided glioma in eloquent areas, who received awake craniotomy during 2016–2020. Montreal Cognitive Assessment Scale, BN-20, and EORTC-QLQ-C30 questionnaire were applied for neurological cognitive assessment. We performed a correlation analysis between changes in cognitive performance and tumor characteristics, including tumor location, pathological grade. Treatment-related factors were also analyzed, such as the extent of resection (EOR), preoperative and postoperative Karnofsky Performance Score (KPS), postoperative treatment strategy (chemo- and radiotherapy), progression-free survival (PFS), overall survival (OS). RESULTS 68 patients were included in our current study. For the language domain, memory domain, and executive functions, 7.4% (5/68) patients presented mild postoperative cognitive performance deterioration compared to preoperative. Tumor location was the only factor that greatly influenced the postoperative cognitive performance, while other features (EOR, KPS, pathological grades) and treatment strategy were found no effect on cognitive change. The extent of tumor resection ranged from 81% to 100%. CONCLUSION Our study underlines the importance of the application of brain mapping during awake craniotomy, which helps to maximize extent of tumor resection while preserving cognitive function in individuals with LGG in eloquent regions.

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.

Awake Craniotomy vs Surgery Under General Anesthesia for Resection of Supratentorial Lesions4

Neurosurgery ◽  
2011 ◽  
Vol 68 (5) ◽  
pp. 1192-1199 ◽  
Author(s):  
Oumar Sacko ◽  
Valérie Lauwers-Cances ◽  
David Brauge ◽  
Musa Sesay ◽  
Adam Brenner ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Brain Mapping ◽  
Neurological Outcome ◽  
Neurological Complication ◽  
Awake Craniotomy ◽  
Neurological Deficits ◽  
Complication Rates ◽  
Eloquent Areas ◽  
Duration Of Surgery

Abstract BACKGROUND: The use of an awake craniotomy in the treatment of supratentorial lesions is a challenge for both patients and staff in the operation theater. OBJECT: To assess the safety and effectiveness of an awake craniotomy with brain mapping in comparison with a craniotomy performed under general anesthesia. METHODS: We prospectively compared 2 groups of patients who underwent surgery for supratentorial lesions: those in whom an awake craniotomy with intraoperative brain mapping was used (AC group, n = 214) and those in whom surgery was performed under general anesthesia (GA group, n = 361, including 72 patients with lesions in eloquent areas). The AC group included lesions in close proximity to the eloquent cortex that were surgically treated on an elective basis. RESULTS: Globally, the 2 groups were comparable in terms of sex, age, American Society of Anesthesiologists score, pathology, size of lesions, quality of resection, duration of surgery, and neurological outcome, and different in tumor location and preoperative neurological deficits (higher in the AC group). However, specific data analysis of patients with lesions in eloquent areas revealed a significantly better neurological outcome and quality of resection (P < .001) in the AC group than the subgroup of GA patients with lesions in eloquent areas. Surgery was uneventful in AC patients and they were discharged home sooner. CONCLUSION: AC with brain mapping is safe and allows maximal removal of lesions close to functional areas with low neurological complication rates. It provides an excellent alternative to craniotomy under GA.

scholarly journals Cerebral tumor resection assisted by electromagnetic tracking frameless stereotactic system

2018 ◽  
Vol 21 (2) ◽  
pp. 93-98
Author(s):  
Eduardo E. Lovo ◽  
Rafael Martínez Cortez ◽  
Rodolfo Milla Flor ◽  
Héctor Moreira
Keyword(s):  
Tumor Resection ◽  
Intraoperative Ultrasound ◽  
Tumor Location ◽  
Cerebral Tumor ◽  
Advantages And Disadvantages ◽  
Stereotactic System ◽  
Brain Tumor Resection ◽  
Eloquent Cortex ◽  
Tracking Device

Introduction: Electromagnetic (EM) technology used as a tracking device in neurosurgery is relatively new and less common than its optical counterpart: only a few companies manufacture such devices. The main objective is to describe the technology that is used in EM tracking (Compass Cygnus), and its advantages and disadvantages in brain tumor resection as it is incorporated in a neuro-oncology program. Methods: We used the Compass Cygnuss-PFS frameless stereotactic system which performs EM tracking (EMFSS); we analyzed the technology used in the system and describe how a procedureis carried out, signalizing its advantages and disadvantages. We then report our initial experience in tumor resections using this technology from august 2008 to january 2009 in the Neuro-oncology Program of the Hospital de Diagnóstico of El Salvador. Results: The EMFSS operates by using a Flock ofBirds Technology (FOB). Twenty patients were operated on using the EMFSS: 18 of them harbored a tumor either primary or secondary in origin. Its precision was considered adequate in 16 cases (88.8 %) when compared to non-mobile, non-deformable structures (cranial base floor, tentorium, falx, etc). Intraoperative ultrasound in two cases: it was considered inadequatedue to brain shift/deformation, in two cases (11.1%) and a re-registration process had to be carried out during surgery. Tumor location was: 5 (27.7%) in non eloquent, 8 (44.4%) near eloquent, and 5 (27.7%) in eloquent cortex. Volumetric tumor resection was 87% (40-100%). Five patients (27.7%) had complications, 4 (80%) of them transient and resolved during 30 day follow-up. One (5.5%) patient had definite neurological worsening. Thirty day mortality was 0. Preoperative Karnofsky Physiological Score (KPS) and at discharge and at one month follow up was 80 (60-90), 80 (60-90) and 80(60-100) respectively. Conclusions: EM tracking is a reliable system when its accuracy is tested against non-mobile structures and ultrasound. It is compact and the “line of sight” does not have to be taken into consideration. Its big advantages are “tailored” craniotomy design and spatial orientations in deepseated tumors, where ultrasound is not efective; its biggest limitation is its incapacity to re-register with anatomical points or landmarks and image fusion or transition.

Awake craniotomy with brain mapping as the routine surgical approach to treating patients with supratentorial intraaxial tumors: a prospective trial of 200 cases

1999 ◽  
Vol 90 (1) ◽  
pp. 35-41 ◽  
Author(s):  
Michael D. Taylor ◽  
Mark Bernstein
Keyword(s):  
Intensive Care ◽  
Surgical Approach ◽  
Brain Mapping ◽  
Prospective Trial ◽  
Awake Craniotomy ◽  
Neurological Deficits ◽  
Total Hospital ◽  
Content Type ◽  
Total Hospital Stay ◽  
Fine Print

Object. Awake craniotomy was performed as the standard surgical approach to supratentorial intraaxial tumors, regardless of the involvement of eloquent cortex, in a prospective trial of 200 patients surgically treated by the same surgeon at a single institution.Methods. Patient presentations, comorbid conditions, tumor locations, and the histological characteristics of lesions were recorded. Brain mapping was possible in 195 (97.5%) of 200 patients. The total number of patients sustaining complications was 33 for an overall complication rate of 16.5%. There were two deaths in this series, for a mortality rate of 1%. New postoperative neurological deficits were seen in 13% of the patients, but these were permanent in only 4.5% of them. Complication rates were higher in patients who had gliomas or preoperative neurological deficits and in those who had undergone prior radiation therapy or surgery. No patient who entered the operating room neurologically intact sustained a permanent neurological deficit postoperatively. Of the most recent 50 patients treated, three (6%) required a stay in the intensive care unit, and the median total hospital stay was 1 day.Conclusions. Use of awake craniotomy can result in a considerable reduction in resource utilization without compromising patient care by minimizing intensive care time and total hospital stay. Awake craniotomy is a practical and effective standard surgical approach to supratentorial tumors with a low complication rate, and provides an excellent alternative to craniotomy performed with the patient in the state of general anesthesia because it allows the opportunity for brain mapping and avoids general anesthesia.

scholarly journals Comparison of conscious sedation and general anesthesia for motor mapping and resection of tumors located near motor cortex

2003 ◽  
Vol 15 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Todd W. Vitaz ◽  
William Marx ◽  
Jonathan D. Victor ◽  
Philip H. Gutin
Keyword(s):  
Motor Cortex ◽  
General Anesthesia ◽  
Conscious Sedation ◽  
Neurological Deficits ◽  
Anesthetic Technique ◽  
Neurophysiological Monitoring ◽  
Motor Mapping ◽  
Eloquent Cortex ◽  
Group 2 ◽  
Group 1

Object The surgical treatment of tumors located near eloquent cortex carries a high risk of inducing worsening neurological deficits. Intraoperative electrocorticography techniques have been developed to help identify these areas at the time of surgery in an effort to minimize such risks. The optimal anesthetic technique for conducting these procedures, however, has never been determined. Methods The authors conducted a retrospective study to compare patients who underwent intraoperative motor mapping between September 2000 and May 2002. Demographic and neurophysiological monitoring data were collected from the hospital records. Patients were divided into two groups based on the anesthetic technique used for surgery: in Group 1 general anesthesia was used, and in Group 2 conscious sedation. Group 1 comprised 24 patients (mean age 47 years) with 16 right- and eight left-sided lesions. Group 2 consisted of 21 patients (mean age 46 years) with 18 right- and three left-sided lesions. Pathological diagnoses were similar between the two groups. Motor stimulation was elicited in 12 patients (50%) in Group 1 and in 21 patients (100%) in Group 2 (p < 0.001). In addition, the mean stimulation amplitude required was significantly higher (13 mA) in patients in whom conscious sedation was used as opposed to general anesthesia (5 mA, p < 0.0001). Electrographic evidence of seizures was seen in 29% of Group 1 cmpared with 10% of Group 2 patients (p > 0.05). Conclusions The use of conscious sedation as an anesthetic technique for motor mapping not only improves the chances of achieving successful stimulation and identification of motor cortex in relationship to the lesion, but it also allows for repetitive monitoring of the patient's motor function during resection of the lesion.

Subcortical Injury Is an Independent Predictor of Worsening Neurological Deficits Following Awake Craniotomy Procedures

Neurosurgery ◽  
2012 ◽  
Vol 72 (2) ◽  
pp. 160-169 ◽  
Author(s):  
Victoria T. Trinh ◽  
Daniel K. Fahim ◽  
Komal Shah ◽  
Sudhakar Tummala ◽  
Ian E. McCutcheon ◽  
...  
Keyword(s):  
Neurological Deficit ◽  
Independent Predictor ◽  
Tumor Resection ◽  
Subcortical White Matter ◽  
Awake Craniotomy ◽  
Neurological Dysfunction ◽  
Neurological Deficits ◽  
Cortical Mapping ◽  
Cortical Injury ◽  
Postoperative Changes

Abstract BACKGROUND: Tailored craniotomies for awake procedures limit cortical exposure. Recently we demonstrated that the identification of eloquent areas increased the risk of postoperative deficits. However, it was not clear whether the observed neurological deficits were caused by proximity of functional cortex to the tumor [cortical injury] or subcortical injury. OBJECTIVE: We hypothesize that subcortical injury during tumor resection is an important predictor of postoperative neurological deficits compared to cortical injury. METHODS: A retrospective review of 214 patients undergoing awake craniotomy was carried out in whom preoperative functional magnetic resonance imaging (fMRI) and cortical mapping (CM) were performed. A radiologist blinded to the clinical data reviewed and graded the postoperative changes on diffusion-weighted MR-imaging (DWI). RESULTS: Of the 40 cases who developed new intraoperative neurological deficit, 36 (90%) occurred during subcortical dissection, 3 (7.5%) during both subcortical and cortical dissection, and 1 (2.5%) during cortical dissection. Neurological dysfunction acquired during subcortical dissection was an independent predictor of postoperative deficits both in the immediate postoperative period (P &lt; .001) and at the 3-month follow-up (P &lt; .001). Significant DWI restriction in the subcortical white matter was predictive of neurological deficits both immediately and at 3 months, P = .011 and P &lt; .001, respectively. New or worsening deficits were seen in 38% of patients; however, at 3 months 13% had a mild persistent neurological deficit. CONCLUSION: Subcortical injury with significant DWI changes result in postoperative neurological decline despite our efforts to preserve cortical areas of function. This underscores the importance of preserving subcortical fiber tracts during awake craniotomy procedures.

Awake craniotomy for gliomas in a high-field intraoperative magnetic resonance imaging suite: analysis of 42 cases

2014 ◽  
Vol 121 (4) ◽  
pp. 810-817 ◽  
Author(s):  
Marcos V. C. Maldaun ◽  
Shumaila N. Khawja ◽  
Nicholas B. Levine ◽  
Ganesh Rao ◽  
Frederick F. Lang ◽  
...  
Keyword(s):  
High Field ◽  
Tumor Resection ◽  
Patient Positioning ◽  
Extent Of Resection ◽  
Awake Craniotomy ◽  
Neurological Deficits ◽  
Speech Mapping ◽  
Duration Of Surgery ◽  
The Mean ◽  
Subcortical Mapping

Object The object of this study was to describe the experience of combining awake craniotomy techniques with high-field (1.5 T) intraoperative MRI (iMRI) for tumors adjacent to eloquent cortex. Methods From a prospective database the authors obtained and evaluated the records of all patients who had undergone awake craniotomy procedures with cortical and subcortical mapping in the iMRI suite. The integration of these two modalities was assessed with respect to safety, operative times, workflow, extent of resection (EOR), and neurological outcome. Results Between February 2010 and December 2011, 42 awake craniotomy procedures using iMRI were performed in 41 patients for the removal of intraaxial tumors. There were 31 left-sided and 11 right-sided tumors. In half of the cases (21 [50%] of 42), the patient was kept awake for both motor and speech mapping. The mean duration of surgery overall was 7.3 hours (range 4.0–13.9 hours). The median EOR overall was 90%, and gross-total resection (EOR ≥ 95%) was achieved in 17 cases (40.5%). After viewing the first MR images after initial resection, further resection was performed in 17 cases (40.5%); the mean EOR in these cases increased from 56% to 67% after further resection. No deficits were observed preoperatively in 33 cases (78.5%), and worsening neurological deficits were noted immediately after surgery in 11 cases (26.2%). At 1 month after surgery, however, worsened neurological function was observed in only 1 case (2.3%). Conclusions There was a learning curve with regard to patient positioning and setup times, although it did not adversely affect patient outcomes. Awake craniotomy can be safely performed in a high-field (1.5 T) iMRI suite to maximize tumor resection in eloquent brain areas with an acceptable morbidity profile at 1 month.

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.

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