Awake Craniotomy for Supratentorial Gliomas: Why, when and how?

Abstract

Awake craniotomy has become an increasingly utilized procedure in the treatment of supratentorial intra-axial tumors. The popularity of this procedure is partially attributable to improvements in intraoperative technology and anesthetic techniques. The application of awake craniotomy to the field of neuro-oncology has decreased iatrogenic postoperative neurological deficits, allowed for safe maximal tumor resection and improved healthcare resource stewardship by permitting early patient discharge. In this article, we review recent evidence for the utility of awake craniotomy in the resection of gliomas and describe the senior author's experience in performing this procedure. Furthermore, we explore innovative applications of awake craniotomy to outpatient tumor resections and the conduct of neurosurgery in resource-poor settings. We conclude that awake craniotomy is an effective and versatile neurosurgical procedure with expanding applications in neuro-oncology.

Awake craniotomy for brain tumor: indications, technique and benefits

“…Technique of brain mapping Bipolar stimulation using a probe with two tips separated by 6-10 mm and a 100-ms square wave pulse with a 50-Hz repetition rate is usually used [55]. The whole exposed cortical surface is mapped sequentially depending on probe spacing.…”

Neurosurgery in conscious patients: forward to the past

“…Именно здесь получены наиболее впечатляющие результаты применения методики КС. Публикаций на эту тему достаточно много, в том числе и наших, причем касающихся самых различных аспектов методики: от нейрохирургических и анестезиологических аспектов, различных осложнений и неудач и до персональных ощущений пациента [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]. Это позволяет не рассматривать здесь эту проблему подробно, а отослать заинтересованного читателя к этим публикациям.…”

Is outpatient brain tumor surgery feasible in India?

“…[14] Since 1991, the senior author has routinely performed awake craniotomy for intra-axial brain tumors with low complication rates and minimum resource utilization. [9,10,12,31] In 1996, a pilot study was initiated at the senior author's hospital in Toronto to assess the feasibility of performing craniotomy for tumor resection as an outpatient procedure. [13] The results of this study were reported in 2001.…”

“…[5][6][7][8] With the advent of awake craniotomy and widespread use of electrophysiological monitoring, brain tumor surgery has become safer, and the postoperative recovery quicker. [9][10][11] This has resulted in fewer postoperative complications and patients being discharged earlier. [12] This evolution has also brought forward the realization that prolonged hospital stay predisposes patients to nosocomial infections and thromboembolic complications, and the overall opinion that patients do better at home than they do in the hospital.…”