Experience with awake throughout craniotomy in tumour surgery: technique and outcomes of a prospective, consecutive case
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ORIGINAL ARTICLE - BRAIN TUMORS
Experience with awake throughout craniotomy in tumour surgery: technique and outcomes of a prospective, consecutive case series with patient perception data Jose E. Leon-Rojas 1 & Justyna O. Ekert 2 & Matthew A. Kirkman 3 & Darreul Sewell 4 & Sotirios Bisdas 5 & George Samandouras 1,3 Received: 19 May 2020 / Accepted: 28 August 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background Awake craniotomy is the standard of care in surgery of tumours located in eloquent parts of the brain. However, high variability is recorded in multiple parameters, including anaesthetic techniques, mapping paradigms and technology adjuncts. The current study is focused primarily on patients’ level of consciousness, surgical technique, and experience based on a cohort of 50 consecutive cases undergoing awake throughout craniotomy (ATC). Methods Data was collected prospectively for 46 patients undergoing 50 operations over 14-month period, by the senior author, including demographics, extent of resection (EOR), adverse intraoperative events, surgical morbidity, surgery duration, levels of O2 saturation and brain oedema. A prospective, patient experience questionnaire was delivered to 38 patients. Results The ATC technique was well tolerated in all patients. Once TCI stopped, all patients were immediately assessable for mapping. Despite > 75% of cases being considered inoperable/high risk, gross total resection (GTR) was achieved in 68% patients and subtotal resection in 20%. The average duration of surgery was 220 min with no episodes of hypoxia. Early and late severe deficits recorded in 12% and 2%, respectively. No stimulation-induced seizures or failed ATCs were recorded. Patient-recorded data showed absent/minimal pain during (1) clamp placement in 95.6% of patients; (2) drilling in 94.7% of patients; (3) surgery in 78.9% of patients. Post-operatively, 92.3% of patients reported willingness to repeat the ATC, if necessary. Conclusions The current ATC paradigm allows immediate brain mapping, maximising patient comfort during selfpositioning. Despite the cohort of challenging tumour location, satisfactory EOR was achieved with acceptable morbidity and no adverse intraoperative events. Keywords Awake throughout craniotomy . Brain mapping . Gross total resection . Patient satisfaction . Glioma surgery
This article is part of the Topical Collection on Brain Tumors Portions of this work were presented in poster form at the European LowGrade Glioma Network meeting 15/06/2019, London and the Congress of Neurological Surgeons 19/10/2019. * Jose E. Leon-Rojas [email protected] George Samandouras [email protected] 1
Institute of Neurology, University College London, Queen Square, London, UK
2
Wellcome Centre for Human Neuroimaging, University College London, 12 Queen Square, London, UK
3
Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
4
Department of Neuroanaesthesia, The National Hospital
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