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

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
• 2 Jakobsson J. Day surgery: an evidenced-based practice.  Curr Opin Anaesthesiol. 2007;  20 501-502
• 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
• 4 Bernstein M. Outpatient craniotomy for brain tumor: a pilot feasibility study in 46 patients.  Can J Neurol Sci. 2001;  28 120-124
• 5 Bhardwaj RD, Bernstein M. Prospective feasibility study of outpatient stereotactic brain lesion biopsy.  Neurosurgery. 2002;  51 358-361 , ; discussion 361-364
• 6 Serletis D, Bernstein M. Prospective study of awake craniotomy used routinely and nonselectively for supratentorial tumors.  J Neurosurg. 2007;  107 1-6
• 7 Boulton M, Bernstein M. Outpatient brain tumor surgery: Innovation in surgical neurooncology.  J Neurosurg. 2008;  108 649-654
• 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
• 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
• 10 Black PM, Ronner SF. Cortical mapping for defining the limits of tumor resection.  Neurosurgery. 1987;  20 914-919
• 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
• 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
• 13 Berger MS. Minimalism through intraoperative functional mapping.  Clin Neurosurg. 1996;  43 324-337
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 22 Frost EA, Booij LH. Anesthesia in the patient for awake craniotomy.  Curr Opin Anaesthesiol. 2007;  20 331-335
• 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
• 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
• 25 Spetzger U, Laborde G, Gilsbach JM. Frameless neuronavigation in modern neurosurgery.  Minim Invas Neurosurg. 1995;  38 163-166
• 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
• 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
• 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
• 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

Correspondence