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Awake craniotomy

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https://www.readbyqxmd.com/read/27895359/awake-craniotomy-for-brain-tumours-in-pakistan-an-initial-case-series-from-a-developing-country
#1
Saad Akhtar Khan, Karim Rizwan Nathani, Badar Uddin Ujjan, Muhammad Danish Barakzai, Syed Ather Enam, Faraz Shafiq
Awake craniotomy offers safe resection of brain tumours in eloquent area. Aga Khan University Hospital, Karachi, recently started the programme in Pakistan, and the current study was planned to assess our experience of the first 16 procedures. The retrospective study comprised all such procedures done from November 2015 to May 2016. Pre-operative and post-operative variables were analysed. Of the 16 patients, 11(68.75%) were males and 5(31.25%) were females. The overall median age was 37 years (interquartile range[IQR]: 23-62 years)...
October 2016: JPMA. the Journal of the Pakistan Medical Association
https://www.readbyqxmd.com/read/27888341/efficacy-of-the-transtemporal-approach-with-awake-brain-mapping-to-reach-the-dominant-posteromedial-temporal-lesions
#2
Kentaro Iijima, Kazuya Motomura, Lushun Chalise, Masaki Hirano, Atsushi Natsume, Toshihiko Wakabayashi
BACKGROUND: Surgeries for lesions in the dominant hippocampal and parahippocampal gyrus involving the posteromedial temporal regions are challenging to perform because they are located close to Wernicke's area; white matter fibers related with language; the optic radiations; and critical neurovascular structures. We performed a transtemporal approach with awake functional mapping for lesions affecting the dominant posteromedial temporal regions. The aim of this study was to assess the feasibility, safety, and efficacy of awake craniotomy for these lesions...
November 25, 2016: Acta Neurochirurgica
https://www.readbyqxmd.com/read/27886157/intraoperative-seizures-and-seizures-outcome-in-patients-underwent-awake-craniotomy
#3
Yang Yuan, Zhou Peizhi, Wang Xiang, Liu Yanhui, Liang Ruofei, Jiang Shu, Mao Qing
BACKGROUND: Awake craniotomies (AC) could reduce neurological deficits compared with patients under general anesthesia, however, intraoperative seizure is a major reason causing awake surgery failure. The purpose of the study was to give a comprehensive overview the published articles focused on seizure incidence in awake craniotomy. METHODS: Bibliographic searches of the EMBASE, MEDLINE,were performed to identify articles and conference abstracts that investigated the intraoperative seizure frequency of patients underwent AC...
November 25, 2016: Journal of Neurosurgical Sciences
https://www.readbyqxmd.com/read/27858231/how-i-do-it-awake-craniotomy
#4
Ciaran Scott Hill, Flavio Severgnini, Edward McKintosh
BACKGROUND: Awake craniotomy allows continuous assessment of a patient's clinical and neurological status during open brain surgery. This facilitates early detection of interference with eloquent cortex, and hence can allow a surgeon to maximize resection margins without compromising neurological function. METHODS: Awake craniotomy requires an effective scalp blockade, intraoperative assessment, and a carefully co-ordinated theatre team. A variety of clinical and electrophysiological techniques can be used to assess cortical function...
November 17, 2016: Acta Neurochirurgica
https://www.readbyqxmd.com/read/27821134/asphyxia-due-to-laryngeal-spasm-as-a-severe-complication-of-awake-deep-brain-stimulation-for-parkinson-s-disease-a-case-report
#5
Kajetan L von Eckardstein, Friederike Sixel-Döring, Stephan Kazmaier, Claudia Trenkwalder, Jason M Hoover, Veit Rohde
BACKGROUND: In accordance with German neurosurgical and neurological consensus recommendations, lead placements for deep brain stimulation (DBS) in patients with Parkinson's disease (PD) are usually performed with the patient awake and in "medication off" state. This allows for optimal lead position adjustment according to the clinical response to intraoperative test stimulation. However, exacerbation of Parkinsonian symptoms after withdrawal of dopaminergic medication may endanger the patient by inducing severe "off" state motor phenomena...
November 8, 2016: BMC Neurology
https://www.readbyqxmd.com/read/27811496/a-case-report-of-onyx-pulmonary-arterial-embolism-contributing-to-hypoxemia-during-awake-craniotomy-for-arteriovenous-malformation-resection
#6
Brian T Tolly, Jenna L Kosky, Antoun Koht, Laura B Hemmer
A healthy 26-year-old man with cerebral arteriovenous malformation underwent staged endovascular embolization with Onyx followed by awake craniotomy for resection. The perioperative course was complicated by tachycardia and severe intraoperative hypoxemia requiring significant oxygen supplementation. Postoperative chest computed tomography (CT) revealed hyperattenuating Onyx embolization material within the pulmonary vasculature, and an electrocardiogram indicated possible right heart strain, supporting clinically significant embolism...
November 2, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27803645/sources-of-variation-influencing-concordance-between-functional-mri-and-direct-cortical-stimulation-in-brain-tumor-surgery
#7
Melanie A Morrison, Fred Tam, Marco M Garavaglia, Gregory M T Hare, Michael D Cusimano, Tom A Schweizer, Sunit Das, Simon J Graham
Object: Preoperative functional magnetic resonance imaging (fMRI) remains a promising method to aid in the surgical management of patients diagnosed with brain tumors. For patients that are candidates for awake craniotomies, surgical decisions can potentially be improved by fMRI but this depends on the level of concordance between preoperative brain maps and the maps provided by the gold standard intraoperative method, direct cortical stimulation (DCS). There have been numerous studies of the concordance between fMRI and DCS using sensitivity and specificity measures, however the results are variable across studies and the key factors influencing variability are not well understood...
2016: Frontiers in Neuroscience
https://www.readbyqxmd.com/read/27771234/comparison-of-conscious-sedation-and-asleep-awake-asleep-techniques-for-awake-craniotomy
#8
Ozlem Korkmaz Dilmen, Eren Fatma Akcil, Abdulvahap Oguz, Hayriye Vehid, Yusuf Tunali
Since awake craniotomy (AC) has become a standard of care for supratentorial tumour resection, especially in the motor and language cortex, determining the most appropriate anaesthetic protocol is very important. The aim of this retrospective study is to compare the effectiveness of conscious sedation (CS) to "awake-asleep-awake" (AAA) techniques for supratentorial tumour resection. Forty-two patients undergoing CS and 22 patients undergoing AAA were included in the study. The primary endpoint was to compare the CS and AAA techniques with respect to intraoperative pain and agitation in patients undergoing supratentorial tumour resection...
October 19, 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/27756671/intraoperative-subcortical-electrical-mapping-of-the-optic-tract-in-awake-surgery-using-virtual-reality-headset
#9
Edouard Mazerand, Marc Le Renard, Sophie Hue, Jean-Michel Lemee, Evelyne Klinger, Philippe Menei
BACKGROUND: Brain mapping during awake craniotomy is a well-known technique to preserve neurological functions, especially the language. It is still challenging to map the optic radiations due to the difficulty to test the visual field intraoperatively. OBJECTIVE: To assess the visual field during awake craniotomy, we developed the Functions' Explorer based on a Virtual Reality Headset (FEX-VRH). METHODS: The impaired visual field of ten patients was tested with the gold standard exam (an automated perimetry), and the FEX-VRH...
October 15, 2016: World Neurosurgery
https://www.readbyqxmd.com/read/27756098/operative-strategies-during-awake-surgery-affect-deterioration-of-paresis-a-month-after-surgery-for-brain-lesions-in-the-primary-motor-area
#10
Nobusada Shinoura, Akira Midorikawa, Ryoji Yamada, Kentaro Hiromitsu, Chihiro Itoi, Shoko Saito, Kazuo Yagi
Introduction We analyzed factors associated with worsened paresis at 1-month follow-up in patients with brain tumors located in the primary motor area (M1) to establish protocols for safe awake craniotomy for M1 lesions. Methods Patients with M1 brain tumors who underwent awake surgery in our hospital (n = 61) were evaluated before, during, and immediately and 1 month after surgery for severity of paresis, tumor location, extent of resection, complications, preoperative motor strength, histology, and operative strategies (surgery stopped or continued after deterioration of motor function)...
October 18, 2016: Journal of Neurological Surgery. Part A, Central European Neurosurgery
https://www.readbyqxmd.com/read/27727417/vakenkirurgi-vid-l%C3%A3-ggradiga-gliom-rekommenderas-goda-resultat-av-7-%C3%A3-rs-erfarenheter-i-link%C3%A3-ping
#11
Peter Milos, Kerstin Metcalf, Patrick Vigren, Hans Lindehammar, Malin Nilsson, Sverre Boström
Awake craniotomy for brain tumours  Awake neurosurgery is a useful method in lesions near eloquent brain areas, particularly low-grade gliomas.The aim is to maximise tumour resection and preserve neurological function. We performed 40 primary awake surgeries and 8 residual surgeries. Patients were operated awake throughout the procedure or with a laryngeal mask and general anaesthesia during the opening stage and then awake during intracerebral surgery. Language and motor function were mapped with direct cortical stimulation, motor evoked potential and standardised neurological testing...
October 11, 2016: Läkartidningen
https://www.readbyqxmd.com/read/27699123/imaging-brain-activity-during-seizures-in-freely-behaving-rats-using-a-miniature-multi-modal-imaging-system
#12
Iliya Sigal, Margaret M Koletar, Dene Ringuette, Raanan Gad, Melanie Jeffrey, Peter L Carlen, Bojana Stefanovic, Ofer Levi
We report on a miniature label-free imaging system for monitoring brain blood flow and blood oxygenation changes in awake, freely behaving rats. The device, weighing 15 grams, enables imaging in a ∼ 2 × 2 mm field of view with 4.4 μm lateral resolution and 1 - 8 Hz temporal sampling rate. The imaging is performed through a chronically-implanted cranial window that remains optically clear between 2 to > 6 weeks after the craniotomy. This imaging method is well suited for longitudinal studies of chronic models of brain diseases and disorders...
September 1, 2016: Biomedical Optics Express
https://www.readbyqxmd.com/read/27695239/surgical-resection-of-low-grade-gliomas-in-eloquent-areas-with-the-guidance-of-the-preoperative-functional-magnetic-resonance-imaging-and-craniometric-points
#13
Ahmed Abdullah, Hisham El Shitany, Waleed Abbass, Amr Safwat, Amr K Elsamman, Ehab El Refaee
OBJECTIVES: Surgical resection of low-grade gliomas (LGGs) in eloquent areas is one of the challenges in neurosurgery, using assistant tools to facilitate effective excision with minimal postoperative neurological deficits has been previously discussed (awake craniotomy and intraoperative cortical stimulation); however, these tools could have their own limitations thus implementation of a simple and effective technique that can guide to safe excision is needed in many situations. MATERIALS AND METHODS: The authors conducted a retrospective analysis of a prospectively collected data of 76 consecutive surgical cases of LGGs of these 21 cases were situated in eloquent areas...
October 2016: Journal of Neurosciences in Rural Practice
https://www.readbyqxmd.com/read/27687404/fiberoptic-nasopharyngoscopy-for-evaluating-a-potentially-difficult-airway-in-a-patient-with-elevated-intracranial-pressure
#14
Lakshmi N Kurnutala, Gurneet Sandhu, Sergio D Bergese
A 62-year-old man with a left temporal lobe tumor was scheduled for a semiurgent craniotomy for tumor excision. Previously, the patient had a laryngeal carcinoma that was resected and treated with chemotherapy and radiotherapy and a history of laryngeal biopsy with awake fiberoptic intubation. Because a difficult airway was anticipated, awake fiberoptic nasopharyngoscopy of the airway was performed under topical anesthesia in the operating room. This revealed a narrow glottic opening with no supraglottic pathology or friable tissue...
November 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27686506/clinical-impact-and-implication-of-real-time-oscillation-analysis-for-language-mapping
#15
Ogawa H, Kamada K, Kapeller C, Pruckle R, Takeuchi F, Hiroshima S, Anei R, Guger G
BACKGROUND: We developed a functional brain analysis system that enabled us to perform real-time task-related electrocorticography (ECoG) and evaluated its potential in clinical practice. We hypothesized that high gamma activity (HGA) mapping would provide better spatial and temporal resolution with high signal-to-noise ratios. METHODS: Seven awake craniotomy patients were evaluated. ECoG was recorded during language tasks using subdural grids, and HGA (60-170 Hz) maps were obtained in real time...
September 26, 2016: World Neurosurgery
https://www.readbyqxmd.com/read/27681862/propofol-pharmacodynamics-and-bispectral-index-during-key-moments-of-awake-craniotomy
#16
Martin Soehle, Christina F Wolf, Melanie J Priston, Georg Neuloh, Christian G Bien, Andreas Hoeft, Richard K Ellerkmann
BACKGROUND: During awake craniotomy, the patient's language centers are identified by neurological testing requiring a fully awake and cooperative patient. Hence, anesthesia aims for an unconscious patient at the beginning and end of surgery but an awake and responsive patient in between. We investigated the plasma (Cplasma) and effect-site (Ceffect-site) propofol concentration as well as the related Bispectral Index (BIS) required for intraoperative return of consciousness and begin of neurological testing...
September 27, 2016: Journal of Neurosurgical Anesthesiology
https://www.readbyqxmd.com/read/27659830/clinical-considerations-and-surgical-approaches-for-low-grade-gliomas-in-deep-hemispheric-locations-insular-lesions
#17
J Hinojosa, S Gil-Robles, B Pascual
Insula and paralimbic region represent a common location for gliomas in adulthood. However, limbic and paralimbic tumors are rare in children. Reports of pediatric insular tumors are scarce in literature, and most of them are included in adult's series, so their management and outcome can be outlined only after extracting data from these reports. Due to their predominantly low grade, they usually have a benign course for some time, what make them ideal candidates for total resection. However, their intricate location and spread to key areas, including the temporal lobe, make them a surgical challenge...
October 2016: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/27659829/awake-surgery-for-hemispheric-low-grade-gliomas-oncological-functional-and-methodological-differences-between-pediatric-and-adult-populations
#18
Gianluca Trevisi, Thomas Roujeau, Hugues Duffau
INTRODUCTION: Brain mapping through a direct cortical and subcortical electrical stimulation during an awake craniotomy has gained an increasing popularity as a powerful tool to prevent neurological deficit while increasing extent of resection of hemispheric diffuse low-grade gliomas in adults. However, few case reports or very limited series of awake surgery in children are currently available in the literature. METHODS: In this paper, we review the oncological and functional differences between pediatric and adult populations, and the methodological specificities that may limit the use of awake mapping in pediatric low-grade glioma surgery...
October 2016: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/27606116/combination-of-continuous-dexmedetomidine-infusion-with-titrated-ultra-low-dose-propofol-fentanyl-for-an-awake-craniotomy
#19
Samaresh Das, Ali Al-Mashani, Neelam Suri, Neeraj Salhotra, Nilay Chatterjee
An awake craniotomy is a continuously evolving technique used for the resection of brain tumours from the eloquent cortex. We report a 29-year-old male patient who presented to the Khoula Hospital, Muscat, Oman, in 2016 with a two month history of headaches and convulsions due to a space-occupying brain lesion in close proximity with the left motor cortex. An awake craniotomy was conducted using a scalp block, continuous dexmedetomidine infusion and a titrated ultra-low-dose of propofolfentanyl. The patient remained comfortable throughout the procedure and the intraoperative neuropsychological tests, brain mapping and tumour resection were successful...
August 2016: Sultan Qaboos University Medical Journal
https://www.readbyqxmd.com/read/27593723/successful-insular-glioma-removal-in-a-deaf-signer-patient-during-an-awake-craniotomy-procedure
#20
Philippe Metellus, Salah Boussen, Maxime Guye, Agnes Trebuchon
BACKGROUND: Resection of tumors located within the insula of the dominant hemisphere represents a technical challenge due to complex anatomy including surrounding vasculature and the relationship to functional (motor and language) structures. We report here the case of a successful resection of a left insular glioma in a native deaf signer during an awake craniotomy. CASE DESCRIPTION: Subject A.G., a congenitally deaf right-handed patient who is a native user of Sign Language, presented a seizure one week before he was referred to our department...
September 1, 2016: World Neurosurgery
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