Patient Perception of Combined Awake Brain Tumor Surgery and Intraoperative 1.5-T Magnetic Resonance Imaging

Goebel, Simone; Nabavi, Arya; Schubert, Sarah; Mehdorn, H. Maximilian

doi:10.1227/01.neu.0000374870.46963.bb

Cited by 55 publications

(51 citation statements)

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“…2,3,[11][12][13][14]18,[22][23][24] In some earlier work we showed that intraoperative multimodality electrophysiological mapping can be seamlessly incorporated into high-field iMRI for tumor resections. 15 Initially when we started the procedure of combining awake craniotomy with high-field iMRI, there were a number of challenges to overcome, including patient comfort and position as well as new draping and anesthetic techniques unique to the iMRI environment.…”

Section: Discussionmentioning

confidence: 99%

“…3,11,12,13,24 In the series described by Leuthardt et al 11 and the case report by Parney et al, 13 an overhead moveable magnet was used for scanning. However, in the other series, 3,12,24 including ours, the position of the magnet was fixed on the floor, and the patient was moved toward the scanner for intraoperative scans. The overall operative time in our patient population was 7.3 hours, which is longer than the times reported in the other published studies.…”

Section: Discussionmentioning

confidence: 99%

“…A few studies have described the awake craniotomy procedure in a high-field (1.5 T) iMRI suite. 3,[11][12][13]24 Our group has previously demonstrated the safety of combining multimodality electrophysiological monitoring with high-field (1.5 T) iMRI for the resection of gliomas in eloquent brain areas. 5 Here we report on a consecutive series of 42 cases (41 patients) treated with awake craniotomy in the high-field iMRI suite and discuss our experience in this patient population.…”

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confidence: 99%

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Awake craniotomy for gliomas in a high-field intraoperative magnetic resonance imaging suite: analysis of 42 cases

Maldaun¹,

Khawja²,

Levine³

et al. 2014

JNS

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Object. The object of this study was to describe the experience of combining awake craniotomy techniques with high-field (1.5 T) intraoperative MRI (iMRI) for tumors adjacent to eloquent cortex.Methods. From a prospective database the authors obtained and evaluated the records of all patients who had undergone awake craniotomy procedures with cortical and subcortical mapping in the iMRI suite. The integration of these two modalities was assessed with respect to safety, operative times, workflow, extent of resection (EOR), and neurological outcome.Results. Between February 2010 and December 2011, 42 awake craniotomy procedures using iMRI were performed in 41 patients for the removal of intraaxial tumors. There were 31 left-sided and 11 right-sided tumors. In half of the cases (21 [50%] of 42), the patient was kept awake for both motor and speech mapping. The mean duration of surgery overall was 7.3 hours (range 4.0-13.9 hours). The median EOR overall was 90%, and gross-total resection (EOR ≥ 95%) was achieved in 17 cases (40.5%). After viewing the first MR images after initial resection, further resection was performed in 17 cases (40.5%); the mean EOR in these cases increased from 56% to 67% after further resection. No deficits were observed preoperatively in 33 cases (78.5%), and worsening neurological deficits were noted immediately after surgery in 11 cases (26.2%). At 1 month after surgery, however, worsened neurological function was observed in only 1 case (2.3%).Conclusions. There was a learning curve with regard to patient positioning and setup times, although it did not adversely affect patient outcomes. Awake craniotomy can be safely performed in a high-field (1.5 T) iMRI suite to maximize tumor resection in eloquent brain areas with an acceptable morbidity profile at 1 month. (http://thejns.org/doi/abs/10.3171/2014.6.JNS132285) Key words • awake craniotomy • cortical mapping • glioma surgery • iMRI • EOR • oncologyAbbreviations used in this paper: DTI = diffusion tensor imaging; DWI = diffusion-weighted imaging; EOR = extent of resection; fMRI = functional MRI; GTR = gross-total resection; iMRI = intraoperative MRI; LMA = laryngeal mask airway; OR = operating room; PR = partial resection; STR = subtotal resection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Awake craniotomy for gliomas in a high-field intraoperative magnetic resonance imaging suite: analysis of 42 cases

Maldaun¹,

Khawja²,

Levine³

et al. 2014

JNS

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“…They also enhance the rate of complete tumor resection by providing surgeons with updated information, allowing them to precisely localize tumor remnants intraoperatively and guide their resection accordingly. 10,17,21,25,31,36 Specifically, the application of iMRI for patients with glioma continues to expand because it can enable maximal resection while maintaining the integrity of uninvolved brain tissue. 12,17,36 Nonetheless, as depicted in a recent Cochrane Review, first-level evidence for the clinical applications of such expensive technologies is still lacking and there is no clear answer with regard to the overall benefit in terms of survival and quality of life (QOL).…”

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confidence: 99%

Contribution of combined intraoperative electrophysiological investigation with 3-T intraoperative MRI for awake cerebral glioma surgery: comprehensive review of the clinical implications and radiological outcomes

Ghinda

Zhang

et al. 2016

FOC

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OBJECTIVE This study aimed to assess the clinical efficiency of combined awake craniotomy with 3-T intraoperative MRI (iMRI)–guided resection of gliomas adjacent to eloquent cortex performed at a single center. It also sought to explore the contribution of iMRI to surgeons' learning process of maximal safe resection of gliomas. METHODS All patients who underwent an awake craniotomy and iMRI for resection of eloquent area glioma during the 53 months between January 2011 and June 2015 were included. The cases were analyzed for short- and long-term neurological outcome, progression-free survival (PFS), overall survival (OS), and extent of resection (EOR). The learning curve was assessed after dividing the cohort into Group A (first 27 months) and Group B (last 26 months). Statistical analyses included univariate logistic regression analysis on clinical and radiological variables. Kaplan-Meier and Cox regression models were used for further analysis of OS and PFS. A p value < 0.05 was considered statistically significant. RESULTS One hundred six patients were included in the study. Over an average follow-up period of 24.8 months, short- and long-term worsening of the neurological function was noted in 48 (46.2%) and 9 (8.7%) cases, respectively. The median and mean EOR were 100% and 92%, respectively, and complete radiographic resection was achieved in 64 (60.4%) patients. The rate of gross-total resection (GTR) in the patients with low-grade glioma (89.06% ± 19.6%) was significantly lower than that in patients with high-grade glioma (96.4% ± 9.1%) (p = 0.026). Thirty (28.3%) patients underwent further resection after initial iMRI scanning, with a 10.1% increase of the mean EOR. Multivariate Cox proportional hazards modeling demonstrated that the final EOR was a significant predictor of PFS (HR 0.225, 95% CI 0.070–0.723, p = 0.012). For patients with high-grade glioma, the GTR (p = 0.033), the presence of short-term motor deficit (p = 0.027), and the WHO grade (p = 0.005) were independent prognostic factors of OS. Performing further resection after the iMRI (p = 0.083) and achieving GTR (p = 0.05) demonstrated a PFS benefit trend for the patients affected by a low-grade glioma. Over time, the rate of performing further resection after an iMRI decreased by 26.1% (p = 0.005). A nonsignificant decrease in the rate of short-term (p = 0.101) and long-term (p = 0.132) neurological deficits was equally noted. CONCLUSIONS Combined awake craniotomy and iMRI is a safe and efficient technique allowing maximal safe resection of eloquent area gliomas with possible subsequent OS and PFS benefits. Although there is a learning curve for applying this technique, it can also improve the surgeon's ability in eloquent glioma surgery.

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“…Goebel, Nabavi, Schubert and Mehdorn (2010) reported that satisfaction with the awake craniotomy was high in 24 out of 25 participants. However similarly to Whittle et al (2005) authors failed to address the 39% of participants, reported in the results, who described minor to moderate difficulties.…”

Section: Patient Experience Of Awake Craniotomymentioning

confidence: 99%

An interpretative phenomenological analysis of the patient experience of awake craniotomy: Brain tumour diagnosis to discharge

Fletcher

Nair

Macniven

et al. 2012

British J Health Psychol

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Thesis AbstractIntroduction. This thesis explored patient experiences of awake craniotomy.Existing literature is scarce and dominated by quantitative methodologies. More recently two qualitative studies have provided a rich, but contrasting, understanding of the patients" experience of awake craniotomy.The methodological weaknesses of the existing literature are addressed, and the rationale for the study justified. Objectives.The aim of the study was to explore seven participants" experiences of awake craniotomy using interpretative phenomenological analysis.Methods. Single-site ethical approval was gained to conduct the study in one NHS Trust. All potential participants were approached who had undergone the awake craniotomy procedure at the NHS Trust. Semi-structured interviews were conducted with participants. Interviews were transcribed verbatim and analysed using an interpretative phenomenological analysis framework.Results. Analysis of transcripts yielded three superordinate themes: selfpreservation, operation environment and information. The superordinate themes were interpreted as interconnected with each other, as well as embedded in a core theme: relationship with the neurosurgeon. The three superordinate themes are presented and discussed within the journal article.The extended paper elaborates on two of these superordinate themes. References 93Appendices 107 Tables Table 1: Interview Schedule 6 Table 2: Participant Information 9 List of AbstractObject: Previous research exploring the patient experience of awake craniotomy has yielded inconsistent results. In the current study the authors aimed to explore the lived experience of having undergone an awake craniotomy in the United Kingdom.Methods: Seven participants took part in the study, which used a qualitative research methodology. Each participant was interviewed using a semi-structured interview schedule. Interviews were audio recorded and transcribed verbatim. Transcripts were analysed using interpretative phenomenological analysis.Results: Three superordinate themes: self-preservation, operation environment and information were identified. It was interpreted that each of these themes was embedded in a core theme: relationship with the neurosurgeon. Conclusions:The relationship with the neurosurgeon appears crucial to the patient experience of awake craniotomy: from brain tumour diagnosis to discharge. This knowledge requires consideration in clinical settings and could lead to improved delivery of care in the future.

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Patient Perception of Combined Awake Brain Tumor Surgery and Intraoperative 1.5-T Magnetic Resonance Imaging

Cited by 55 publications

References 28 publications

Awake craniotomy for gliomas in a high-field intraoperative magnetic resonance imaging suite: analysis of 42 cases

Awake craniotomy for gliomas in a high-field intraoperative magnetic resonance imaging suite: analysis of 42 cases

Contribution of combined intraoperative electrophysiological investigation with 3-T intraoperative MRI for awake cerebral glioma surgery: comprehensive review of the clinical implications and radiological outcomes

An interpretative phenomenological analysis of the patient experience of awake craniotomy: Brain tumour diagnosis to discharge

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