Awake surgery: multidisciplinary customized protocol for functional brain mapping
EANS Academy. Messina R. 10/04/21; 339234; EP03104
Raffaella Messina
Contributions
Contributions
Abstract
Background: The use of intraoperative electrical stimulation for brain mapping is extensively used as an aid to the treatment of mass lesions located in or near eloquent areas, with a wide variety of protocols. However, compliance of the patients with intraoperative testing and appropriate choice of customized tasks affect the reliability of results. In order to assess the reliability and validity of a multidisciplinary protocol for awake brain mapping we analysed the results of a protocol that we applied consistently for a consecutive recent series of patients.
Methods: A thorough pre-operative neurosurgical, anaesthesiologic and neuropsychological assessment was conducted, aiming at verifying the feasibility of the procedure (see Tab.1) and tailoring a customized intraoperative anaesthesiologic and mapping protocol for each patient, based on both patient and lesion features.
Results: 17 patients underwent awake craniotomy, maximizing patients’ compliance through listening of personalized music selection before testing. For all of them monitored anaesthesia care was deemed the preferred anaesthesiologic regimen. Intraoperative tasks were chosen based on patients’ occupations and lifestyle and relationship between tumor and cortical and subcortical functional networks. Fifteen patients (90%) had a lesion in the left hemisphere, which was a high grade glioma in 10 cases, a low grade glioma in 4, a meningioma in 2 and a cavernous malformation in one. No severe complications occurred intraoperatively, with occasional presentation of pain and nausea and no false positives or negatives in cortical and subcortical mapping.
Conclusions: Our protocol proved to be reliable, valid and safe, with an excellent grade of tolerance from the patients.
Table 1. Inclusion and exclusion criteria
Methods: A thorough pre-operative neurosurgical, anaesthesiologic and neuropsychological assessment was conducted, aiming at verifying the feasibility of the procedure (see Tab.1) and tailoring a customized intraoperative anaesthesiologic and mapping protocol for each patient, based on both patient and lesion features.
Results: 17 patients underwent awake craniotomy, maximizing patients’ compliance through listening of personalized music selection before testing. For all of them monitored anaesthesia care was deemed the preferred anaesthesiologic regimen. Intraoperative tasks were chosen based on patients’ occupations and lifestyle and relationship between tumor and cortical and subcortical functional networks. Fifteen patients (90%) had a lesion in the left hemisphere, which was a high grade glioma in 10 cases, a low grade glioma in 4, a meningioma in 2 and a cavernous malformation in one. No severe complications occurred intraoperatively, with occasional presentation of pain and nausea and no false positives or negatives in cortical and subcortical mapping.
Conclusions: Our protocol proved to be reliable, valid and safe, with an excellent grade of tolerance from the patients.
Table 1. Inclusion and exclusion criteria
| INCLUSION CRITERIA | EXCLUSION CRITERIA |
| Mass lesion within or adjacent to functional areas based on anatomic and clinical criteria | Neurological impairment hindering testing |
| Multidisciplinary indication for elective surgical resection | Patient’s refusal – lack of motivation – inability to cooperate -– OSAS – severe obesity (BMI > 40) – difficult airways control |
| 18 < Age < 80 - ASA < 3 | Age < 18 or > 80 - ASA > 3 |
Background: The use of intraoperative electrical stimulation for brain mapping is extensively used as an aid to the treatment of mass lesions located in or near eloquent areas, with a wide variety of protocols. However, compliance of the patients with intraoperative testing and appropriate choice of customized tasks affect the reliability of results. In order to assess the reliability and validity of a multidisciplinary protocol for awake brain mapping we analysed the results of a protocol that we applied consistently for a consecutive recent series of patients.
Methods: A thorough pre-operative neurosurgical, anaesthesiologic and neuropsychological assessment was conducted, aiming at verifying the feasibility of the procedure (see Tab.1) and tailoring a customized intraoperative anaesthesiologic and mapping protocol for each patient, based on both patient and lesion features.
Results: 17 patients underwent awake craniotomy, maximizing patients’ compliance through listening of personalized music selection before testing. For all of them monitored anaesthesia care was deemed the preferred anaesthesiologic regimen. Intraoperative tasks were chosen based on patients’ occupations and lifestyle and relationship between tumor and cortical and subcortical functional networks. Fifteen patients (90%) had a lesion in the left hemisphere, which was a high grade glioma in 10 cases, a low grade glioma in 4, a meningioma in 2 and a cavernous malformation in one. No severe complications occurred intraoperatively, with occasional presentation of pain and nausea and no false positives or negatives in cortical and subcortical mapping.
Conclusions: Our protocol proved to be reliable, valid and safe, with an excellent grade of tolerance from the patients.
Table 1. Inclusion and exclusion criteria
Methods: A thorough pre-operative neurosurgical, anaesthesiologic and neuropsychological assessment was conducted, aiming at verifying the feasibility of the procedure (see Tab.1) and tailoring a customized intraoperative anaesthesiologic and mapping protocol for each patient, based on both patient and lesion features.
Results: 17 patients underwent awake craniotomy, maximizing patients’ compliance through listening of personalized music selection before testing. For all of them monitored anaesthesia care was deemed the preferred anaesthesiologic regimen. Intraoperative tasks were chosen based on patients’ occupations and lifestyle and relationship between tumor and cortical and subcortical functional networks. Fifteen patients (90%) had a lesion in the left hemisphere, which was a high grade glioma in 10 cases, a low grade glioma in 4, a meningioma in 2 and a cavernous malformation in one. No severe complications occurred intraoperatively, with occasional presentation of pain and nausea and no false positives or negatives in cortical and subcortical mapping.
Conclusions: Our protocol proved to be reliable, valid and safe, with an excellent grade of tolerance from the patients.
Table 1. Inclusion and exclusion criteria
| INCLUSION CRITERIA | EXCLUSION CRITERIA |
| Mass lesion within or adjacent to functional areas based on anatomic and clinical criteria | Neurological impairment hindering testing |
| Multidisciplinary indication for elective surgical resection | Patient’s refusal – lack of motivation – inability to cooperate -– OSAS – severe obesity (BMI > 40) – difficult airways control |
| 18 < Age < 80 - ASA < 3 | Age < 18 or > 80 - ASA > 3 |
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