Awake craniotomy

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Awake craniotomy
Specialtyneurology

Awake craniotomy is a

brain damage. During the surgery, the neurosurgeon performs cortical mapping to identify vital areas, called the "eloquent brain
", that should not be disturbed while removing the tumor.

Uses

A particular use for awake craniotomy is mapping the

glioblastomas, gliomas, and brain metastases.[1][2][3][4] It can also be used for epilepsy surgery to remove a larger amount of the section of tissue causing the seizures without damaging function, for deep brain stimulation placement, or for pallidotomy.[2][4] Awake craniotomy has increased the scope of tumors that are considered resectable (treatable by surgery) and in general, reduces recovery time.[2][5] Awake craniotomy is also associated with reduced iatrogenic brain damage after surgery.[6]

Technique

Before an awake craniotomy begins for tumor or epilepsy surgery, the patient is given

conscious sedation. In an AAA surgery, the patient is only awake during the cortical mapping; whereas in an MAC surgery the patient is awake the entire time.[5]

The procedure for deep brain stimulation placement is similar, though instead of skull being removed, a burr hole is drilled for the electrodes instead and the MAC surgery is more common.[5]

Complications

The complications of awake craniotomy are similar to complications from brain surgery done under general anesthesia –

hemorrhage, stroke or air embolism, and death.[1][5] Seizures are the most common complication.[4]

Contraindications

There are patients for whom an awake craniotomy is not appropriate. Those with anxiety disorders, claustrophobia, schizophrenia, or low pain tolerance are poor candidates for an awake surgery because any treatment of a psychological crisis would harm the procedure and could harm the patient.[5] Additionally, patients with obstructive sleep apnea are usually considered poor candidates due to problems with oxygenation, ventilation, and a potentially difficult airway.[7]

References

  1. ^
    S2CID 35732214
    .
  2. ^
    PMID 25054301
    .
  3. S2CID 6318120
    .
  4. ^
    S2CID 207193843
    .
  5. ^
    PMID 22901609
    .
  6. S2CID 25386825
    .
  7. ^ Wong, Jaclyn, Kong, Amy, Lam, Sau, Woo, Peter. High-Flow Nasal Oxygen in Patient With Obstructive Sleep Apnea Undergoing Awake Craniotomy: A Case Report. A&A Case Reports. 2017;9(12):353-356. doi:10.1213/XAA.0000000000000615.
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