Awake Craniotomy for Intra-Axial Brain Lesion Close to Sensory/Motor Cortex; Technique and Clinical Outcome
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- Category: Vol. 85, June 2017
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Awake Craniotomy for Intra-Axial Brain Lesion Close to Sensory/Motor Cortex; Technique and Clinical Outcome, HESHAM ABO RAHMA, AHMED AZAB, AHMED ABD EL-AZIZ and REHAB ALNEMR
Abstract
Background: Awake craniotomy is a technique to conserve function during brain tumor surgery. The first brain mapping with electrical stimulation in humans was generated by R Bartholow in 1874. The rationale for awake craniotomy in tumour resection is that it allows for brain mapping, which facilitates maximum resection and minimizes the risk of post-operative neurological deficit. The three main anaesthesia techinques used for awake craniotomy include Monitored Anesthesia Care (MAC), Asleep-Awake-Asleep (AAA), awake-awake-awake technique. Appropriate patient selection, pre-operative psychological preparation rapport building between patient and anesthesiologists, comfort in patient positioning, anesthetic technique selection, appropriate intra-operative monitoring are of crucial importance to avoid intra operative complications that might occur during anesthesia.
Material and Methods: A total of 17 patients with intra axial brain lesion were admitted to Neurosurgery Department, Menofyiea University Hospital, Qabari Hospital Alexandria Egypt, in the period between March 2013 and January 2015. All patients were operated using awake craniotomy using the asleep-awake-asleep technique all patients had post-operative contrast MRI scan 24 hours post-operative to evaluate the extent of tumor resection.
Results: All of the 17 patients had uneventful operative procedure except three patients two were very agitated once we started the awake phase of the anesthesia, and one devel-oped seizures that was not aborted by iced ringer wash so the procedure was converted to general anesthesia and surgical procedure was carried out gross total resection of the lesions was achieved in almost 70% of patients, astrocytoma grade II followed by oligodendroglioma grade II were the most common histologically confirmed lesions. Post-operative complications include transient hemiparesis in three patients, post-operative seizures in one patient, wound infection in one patient, tumor bed hematoma in one patient.
Conclusion: Awake craniotomy is a safe technique with fruitful results for patients harboring intra axial lesion close to motor cortex, however proper patient selection and adequate pre-operative preparation, together with efficient anesthesia team are the main pillars to carry out this procedure safely.