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Awake craniotomy

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
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
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
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
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
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
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
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
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
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
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
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
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
Kotoe Kamata, Nobutada Morioka, Takashi Maruyama, Noriaki Komayama, Masayuki Nitta, Yoshihiro Muragaki, Takakazu Kawamata, Makoto Ozaki
PURPOSE: Intraoperative vomiting leads to serious respiratory complications that could influence the surgical decision-making process for awake craniotomy. However, the use of antiemetics is still limited in Japan. The aim of this study was to investigate the effect of prophylactically administered single low-dose dexamethasone on the incidence of vomiting during awake craniotomy. The frequency of hyperglycemia was also examined. METHODS: We conducted a retrospective case review of awake craniotomy for glioma resection between 2012 and 2015...
August 29, 2016: Journal of Anesthesia
Lashmi Venkatraghavan, Suparna Bharadwaj, Karolyn Au, Mark Bernstein, Pirjo Manninen
PURPOSE: Enhanced Recovery After Surgery is a multimodal perioperative care pathway designed to achieve early discharge in patients undergoing major surgery. Recent advances in neurosurgery allow for shorter duration of anesthesia and surgery, faster recovery, and earlier discharge from hospital. The purpose of this retrospective observational study was to assess the incidence of early discharge from hospital in patients undergoing craniotomy for supratentorial brain tumours as well as to explore the associated perioperative factors, anesthesia techniques, and complications...
November 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Taner Tanriverdi, Rahsan Kemerdere, Oguz Baran, Sima Sayyahmelli, Fatma Ozlen, Cihan Isler, Mustafa Uzan, Emin Ozyurt
INTRODUCTION: Low-grade gliomas are infrequent lesions requiring special emphasis because of their relatively long follow-up time, and therefore the need for patients' well-being. Surgery provides not only increased survival but also improved quality of life for these patients. The purpose of this study was to present surgical series of frontal low-grade gliomas that were operated in our clinic and to discuss their epileptic and functional outcomes. METHODS: A series of 40 patients with low-grade glioma (WHO Grade II) were retrospectively analysed for patient characteristics, tumour location, epileptic history, surgery type (awake craniotomy, general anaesthesia), extent of resection and complications...
September 2016: International Journal of Surgery
Matthew K Leonard, Ruofan Cai, Miranda C Babiak, Angela Ren, Edward F Chang
Verbal repetition requires the coordination of auditory, memory, linguistic, and motor systems. To date, the basic dynamics of neural information processing in this deceptively simple behavior are largely unknown. Here, we examined the neural processes underlying verbal repetition using focal interruption (electrocortical stimulation) in 58 patients undergoing awake craniotomies, and neurophysiological recordings (electrocorticography) in 8 patients while they performed a single word repetition task. Electrocortical stimulation revealed that sub-components of the left peri-Sylvian network involved in single word repetition could be differentially interrupted, producing transient perceptual deficits, paraphasic errors, or speech arrest...
July 19, 2016: Brain and Language
Jessica W Templer, Jay R Gavvala, Matthew C Tate, Stephan U Schuele
No abstract text is available yet for this article.
July 2016: World Neurosurgery
Adriana de Pesters, AmiLyn M Taplin, Matthew A Adamo, Anthony L Ritaccio, Gerwin Schalk
OBJECTIVE: Patients requiring resective brain surgery often undergo functional brain mapping during perioperative planning to localize expressive language areas. Currently, all established protocols to perform such mapping require substantial time and patient participation during verb generation or similar tasks. These issues can make language mapping impractical in certain clinical circumstances (e.g., during awake craniotomies) or with certain populations (e.g., pediatric patients)...
2016: Epilepsy & Behavior Case Reports
Rafael Badenes, María L García-Pérez, Federico Bilotta
PURPOSE OF REVIEW: This review reports recent evidence on intraoperative monitoring of cerebral oximetry and depth of anaesthesia during neuroanaesthesia procedures. RECENT FINDINGS: The clinical benefits of intraoperative monitoring with cerebral oximetry [near infrared spectroscopy (NIRS) and brain tissue oxygenation monitoring (brptiO2)] and depth of anaesthesia with bispectral index (BIS) have recently been studied in surgical (carotid endarterectomy, cerebral arteriovenous malformations resection and brain tumour resections) and neuroradiological vascular procedures...
October 2016: Current Opinion in Anaesthesiology
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