Anaesthetic Management of Cerebral Arterio-venous Malformation Excision Using Awake Craniotomy: Initial Experience of Two Cases

Ghaffar, Waleed Bin; Ahsan, Khalid; Shafiq, Faraz; Enam, Ather

doi:10.29271/jcpsp.2019.12.s74

Cited by 5 publications

(7 citation statements)

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“…A total of 11 studies with 106 patients who underwent AC were included in the present systematic review ( 1 , 4 , 10-18 ). More specifically, of the eligible studies included, six studies were conducted in the USA, two studies were conducted in China, and three studies were conducted in Japan, Pakistan, and Switzerland.…”

Section: Resultsmentioning

confidence: 99%

“…Cerebral vascular malformations present a range of lesions, among which arteriovenous malformation (AVM) is the most common ( 1 ). The management of AVM involves a multi-disciplinary approach and often requires a combination of treatments, including surgery, embolization and radiosurgery (RS) ( 2 , 3 ).…”

Section: Introductionmentioning

confidence: 99%

“…The management of AVM involves a multi-disciplinary approach and often requires a combination of treatments, including surgery, embolization and radiosurgery (RS) ( 2 , 3 ). The surgical removal of an arteriovenous malformation (AVM) can be challenging for any neurosurgeon ( 1 , 2 ). Depending on an the anatomic complexity, size and position of AVMs with regard to eloquent areas, a long surgical or a multidisciplinary team and numerous sessions may be required to achieve maximum resection ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

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Awake craniotomy in patients with arteriovenous malformation: A systematic review and meta‑analysis

Harikrishna,

Chatzidakis,

Ishak

et al. 2024

Med Int

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The present systematic review aimed to identify all the available literature on awake craniotomy (AC) in patients with arteriovenous malformation (AVM) in order to evaluate its safety, risks, benefits and effectiveness. All available literature on AC in patients with AVM was collected and evaluated in an aim to provide a better understanding of its safety, associated risks and benefits. A systematic search for studies employing AC in patients with AVM was conducted using the PubMed, Scopus and ScienceDirect databases without restrictions on the year of publication, language, or study design, from inception up to May 30, 2021. A total of 11 studies published between 2004 and 2021 with 106 patients who underwent ACs were considered eligible. The rate of complete resection was 93% [95% confidence interval (CI), 82 to 100%; I 2 0%]. The intraoperative complication rate was 21% (95% CI, 1 to 41%; I 2 55%) and the post-operative complication rate was 33% (95% CI, 19 to 48%; I 2 40%). During follow-up, the complication rate was 6% (95% CI, 1 to 10%; I 2 30%). The post-operative complication rate was higher in the Spetzler-Martin grade (SMG) III-V group (31%; 95% CI, 21 to 42%; I 2 46%) than in the SMG I-II group (12%; 95% CI, 2 to 22%; I 2 0%). Similarly, the follow-up complication rate was higher in the SMG III-V group (9%; 95% CI, 2 to 16%; I 2 34%) than in the SMG I-II group (0%; 95% CI, 0 to 4%; I 2 0%). On the whole, the present study provides preliminary evidence to indicate that AC is a possible and useful option for the resection of AVM in selected patients. Well-designed future studies with long-term follow-up are required however, to investigate various aspects of safety and provide solid data for AC in patients with AVM.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Awake craniotomy in patients with arteriovenous malformation: A systematic review and meta‑analysis

Harikrishna,

Chatzidakis,

Ishak

et al. 2024

Med Int

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“…Fentanyl was mainly used at time of GA. Post procedural analgesia was prescribed using intermittent doses of IV Paracetamol and Tramadol, as per our Neuro-anaesthesia protocol. 14 …”

Section: Discussionmentioning

confidence: 99%

Anaesthetic management of patients undergoing deep brain simulation: A retrospective review of 8 cases from a tertiary care center of Pakistan

et al. 2020

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Objectives: To review anaesthesia related outcome, perioperative complications and overall length of stay (LOS) in hospital for patients who had deep brain stimulation (DBS). Methods: The study was retrospective review of patients medical records diagnosed with Parkinson disease (PD) and underwent DBS at The Aga Khan University Hospital, Karachi from 2017-2019. Data was reviewed from file notes and patient chart and recorded on predesigned Performa. Frequency and percentages were used to present the data. Results: All patients were anaesthetized using Sleep-Awake-Sleep technique (SAS). Dexmedetomidine was mainly used for conscious sedation. Bispectral index monitor (BIS) was used to monitor the depth of sedation, and kept between 70-85 during sedative phase. All patients had successful intraoperative neurological monitoring, stimulation, and placement of electrodes. Total duration of anesthesia varied significantly in between the patients. Maximum duration was 600 minutes. None of our patient had any intraoperative event related to anaesthetic management. Overall five patients had some adverse events during ward stay. Mean LOS in hospital was four days. Conclusion: Anaesthetic management of DBS is well-tolerated. It requires dedicated team. The SAS technique is excellent for intraoperative neurophysiological monitoring. Careful selection of sedative agents and monitoring depth of anaesthesia using BIS would be beneficial in terms of improving related outcomes. doi: https://doi.org/10.12669/pjms.36.7.2870 How to cite this:Ahmed U, Shafiq F, Kumar D, Ahsan K, Ghaffar W, Bari E. Anaesthetic management of patients undergoing deep brain simulation: A retrospective review of 8 cases from a tertiary care center of Pakistan. Pak J Med Sci. 2020;36(7):---------. doi: https://doi.org/10.12669/pjms.36.7.2870 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“… 17 , 18 Anesthetic management plays a significant role in the surgical outcome. 19 Although commonly utilized for diffuse glioma and epilepsy surgery, AC has evolved through time to incorporate distinct lesions. 20 , 21 Awake mapping for AVMs may be used for cortical mapping, especially for large unruptured AVMs with high Spetzler-Martin grades adjacent to eloquent areas through defining margins that allow safe, effective resection with real-time feedback to neurosurgeons.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of awake craniotomy for brain arteriovenous malformations: A scoping review

Tariq,

Siddiqui,

Bajwa

et al. 2024

World Neurosurgery: X

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Anaesthetic Management of Cerebral Arterio-venous Malformation Excision Using Awake Craniotomy: Initial Experience of Two Cases

Cited by 5 publications

References 0 publications

Awake craniotomy in patients with arteriovenous malformation: A systematic review and meta‑analysis

Awake craniotomy in patients with arteriovenous malformation: A systematic review and meta‑analysis

Anaesthetic management of patients undergoing deep brain simulation: A retrospective review of 8 cases from a tertiary care center of Pakistan

Feasibility of awake craniotomy for brain arteriovenous malformations: A scoping review

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