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Minim Invasive Neurosurg 2008; 51(4): 208-210
DOI: 10.1055/s-2008-1073132
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Day Surgery Awake Craniotomy for Removing Brain Tumours: Technical Note Describing a Simple Protocol

G. Carrabba 1 , L. Venkatraghavan 2 , M. Bernstein 1
  • 1Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
  • 2Department of Anaesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
Further Information

Publication History

Publication Date:
05 August 2008 (online)

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Abstract

Day surgery awake craniotomy has been recently proposed for patients harbouring supratentorial brain tumours. This technique has been demonstrated to be safe and effective in a large cohort of patients operated by one neurosurgeon at the University of Toronto. The aim of this paper is to present a technical description of the protocol that has been adopted for these patients and a discussion of relevant practical issues which may arise. In particular, patient eligibility criteria are briefly discussed and intra- and post-operative management are presented. Key messages for those who are going to start to perform day surgery awake craniotomies include the preparation of a fast, simple and standardized protocol for the treatment of these patients and cooperation among patients and their care-givers (surgeon, anesthetist, nurses, family members).

Key words

awake craniotomy - day surgery - awake anaesthesia - brain mapping

References

  • 1 Shnaider I, Chung F. Outcomes in day surgery.  Curr Opin Anaesthesiol. 2006;  19 622-629
    CrossrefPubMedGoogle Scholar
  • 2 Jakobsson J. Day surgery: an evidenced-based practice.  Curr Opin Anaesthesiol. 2007;  20 501-502
    CrossrefPubMedGoogle Scholar
  • 3 Taylor MD, Bernstein M. Awake craniotomy with brain mapping as the routine surgical approach to treating patients with supratentorial intraaxial tumors: a prospective trial of 200 cases.  J Neurosurg. 1999;  90 35-41
    CrossrefPubMedGoogle Scholar
  • 4 Bernstein M. Outpatient craniotomy for brain tumor: a pilot feasibility study in 46 patients.  Can J Neurol Sci. 2001;  28 120-124
    PubMedGoogle Scholar
  • 5 Bhardwaj RD, Bernstein M. Prospective feasibility study of outpatient stereotactic brain lesion biopsy.  Neurosurgery. 2002;  51 358-361 , ; discussion 361-364
    CrossrefPubMedGoogle Scholar
  • 6 Serletis D, Bernstein M. Prospective study of awake craniotomy used routinely and nonselectively for supratentorial tumors.  J Neurosurg. 2007;  107 1-6
    CrossrefPubMedGoogle Scholar
  • 7 Boulton M, Bernstein M. Outpatient brain tumor surgery: Innovation in surgical neurooncology.  J Neurosurg. 2008;  108 649-654
    CrossrefPubMedGoogle Scholar
  • 8 Blanshard HJ, Chung F, Manninen PH, Taylor MD, Bernstein M. Awake craniotomy for removal of intracranial tumor: considerations for early discharge.  Anesthes Analges. 2001;  92 89-94
    PubMedGoogle Scholar
  • 9 Danks RA, Aglio LS, Gugino LD, Black PM. Craniotomy under local anesthesia and monitored conscious sedation for the resection of tumors involving eloquent cortex.  J Neuro-oncol. 2000;  49 131-139
    CrossrefPubMedGoogle Scholar
  • 10 Black PM, Ronner SF. Cortical mapping for defining the limits of tumor resection.  Neurosurgery. 1987;  20 914-919
    CrossrefPubMedGoogle Scholar
  • 11 Berger MS, Kincaid J, Ojemann GA, Lettich E. Brain mapping techniques to maximize resection, safety, and seizure control in children with brain tumors.  Neurosurgery. 1989;  25 786-792
    CrossrefPubMedGoogle Scholar
  • 12 Ojemann G, Ojemann J, Lettich E, Berger M. Cortical language localization in left, dominant hemisphere. An electrical stimulation mapping investigation in 117 patients.  J Neurosurg. 1989;  71 316-326
    CrossrefPubMedGoogle Scholar
  • 13 Berger MS. Minimalism through intraoperative functional mapping.  Clin Neurosurg. 1996;  43 324-337
    PubMedGoogle Scholar
  • 14 Duffau H, Capelle L, Sichez J, Faillot T, Abdennour L, Law Koune JD, Dadoun S, Bitar A, Arthuis F, Effenterre R Van, Fohanno D. Intra-operative direct electrical stimulations of the central nervous system: the Salpetriere experience with 60 patients.  Acta Neurochir. 1999;  141 1157-1167
    CrossrefPubMedGoogle Scholar
  • 15 Duffau H, Capelle L, Denvil D, Sichez N, Gatignol P, Taillandier L, Lopes M, Mitchell MC, Roche S, Muller JC, Bitar A, Sichez JP, Effenterre R van. Usefulness of intraoperative electrical subcortical mapping during surgery for low-grade gliomas located within eloquent brain regions: functional results in a consecutive series of 103 patients.  J Neurosurg. 2003;  98 764-778
    CrossrefPubMedGoogle Scholar
  • 16 Keles GE, Lundin DA, Lamborn KR, Chang EF, Ojemann G, Berger MS. Intraoperative subcortical stimulation mapping for hemispherical perirolandic gliomas located within or adjacent to the descending motor pathways: evaluation of morbidity and assessment of functional outcome in 294 patients.  J Neurosurg. 2004;  100 369-375
    CrossrefPubMedGoogle Scholar
  • 17 Duffau H, Lopes M, Arthuis F, Bitar A, Sichez JP, Effenterre R Van, Capelle L. Contribution of intraoperative electrical stimulations in surgery of low grade gliomas: a comparative study between two series without (1985-96) and with (1996-2003) functional mapping in the same institution.  J Neurol Neurosurg Psychiatry. 2005;  76 845-851
    CrossrefPubMedGoogle Scholar
  • 18 Bello L, Gallucci M, Fava M, Carrabba G, Giussani C, Acerbi F, Baratta P, Songa V, Conte V, Branca V, Stocchetti N, Papagno C, Gaini SM. Intraoperative subcortical language tract mapping guides surgical removal of gliomas involving speech areas.  Neurosurgery. 2007;  60 67-80 , ; discussion 80-82
    PubMedGoogle Scholar
  • 19 Huncke K, Wiele B Van de, Fried I, Rubinstein EH. The asleep-awake-asleep anesthetic technique for intraoperative language mapping.  Neurosurgery. 1998;  42 1312-1316 , ; discussion 1316-1317
    CrossrefPubMedGoogle Scholar
  • 20 Sarang A, Dinsmore J. Anaesthesia for awake craniotomy – evolution of a technique that facilitates awake neurological testing.  Br J Anaesthes. 2003;  90 161-165
    PubMedGoogle Scholar
  • 21 Keifer JC, Dentchev D, Little K, Warner DS, Friedman AH, Borel CO. A retrospective analysis of a remifentanil/propofol general anesthetic for craniotomy before awake functional brain mapping.  Anesthes Analges. 2005;  101 502-508
    CrossrefPubMedGoogle Scholar
  • 22 Frost EA, Booij LH. Anesthesia in the patient for awake craniotomy.  Curr Opin Anaesthesiol. 2007;  20 331-335
    CrossrefPubMedGoogle Scholar
  • 23 Elisevich KV, Colohan AR, Brem S, Comair Y. A rapid and modifiable technique for regional exposure in cerebral surgery. Technical note.  J Neurosurg. 1987;  67 140-142
    CrossrefPubMedGoogle Scholar
  • 24 Nair S, Giannakopoulos G, Granick M, Solomon M, MacCormack T, Black P. Surgical management of radiated scalp in patients with recurrent glioma.  Neurosurgery. 1994;  34 103-106 , ; discussion 106–107
    CrossrefPubMedGoogle Scholar
  • 25 Spetzger U, Laborde G, Gilsbach JM. Frameless neuronavigation in modern neurosurgery.  Minim Invas Neurosurg. 1995;  38 163-166
    Google Scholar
  • 26 Danks RA, Rogers M, Aglio LS, Gugino LD, Black PM. Patient tolerance of craniotomy performed with the patient under local anesthesia and monitored conscious sedation.  Neurosurgery. 1998;  42 28-34 , ; discussion 34–26
    CrossrefPubMedGoogle Scholar
  • 27 Voges J, Schroder R, Treuer H, Pastyr O, Schlegel W, Lorenz WJ, Sturm V. CT-guided and computer assisted stereotactic biopsy. Technique, results, indications.  Acta neurochirurg. 1993;  125 142-149
    CrossrefPubMedGoogle Scholar
  • 28 Kulkarni AV, Guha A, Lozano A, Bernstein M. Incidence of silent hemorrhage and delayed deterioration after stereotactic brain biopsy.  J Neurosurg. 1998;  89 31-35
    CrossrefPubMedGoogle Scholar
  • 29 Yu X, Liu Z, Tian Z, Li S, Huang H, Xiu B, Zhao Q, Liu L, Jing W. Stereotactic biopsy for intracranial space-occupying lesions: clinical analysis of 550 cases.  Stereotact Funct Neurosurg. 2000;  75 103-108
    CrossrefPubMedGoogle Scholar

Correspondence

Dr. M. Bernstein

Toronto Western Hospital

399 Bathurst Street 4W451

Toronto

Ontario

Canada M5T 2S8

Phone: +1/416/603 64 99

Fax: +1/416/603 52 98

Email: mark.bernstein@uhn.on.ca