Anesth Pain Med.  2020 Jul;15(3):269-274. 10.17085/apm.20050.

Anesthetic considerations for awake craniotomy

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea

Abstract

Awake craniotomy is a gold standard of care for resection of brain tumors located within or close to the eloquent areas. Both asleep-awake-asleep technique and monitored anesthesia care have been used effectively for awake craniotomy and the choice of optimal anesthetic approach is primarily based on the preferences of the anesthesiologist and surgical team. Propofol, remifentanil, dexmedetomidine, and scalp nerve block provide the reliable conditions for intraoperative brain mapping. Appropriate patient selection, adequate perioperative psychological support, and proper anesthetic management for individual patients in each stage of surgery are crucial for procedural safety, success, and patient satisfaction.

Keyword

Anesthesia; Awake craniotomy; Brain tumor; Monitored anesthesia care

Reference

1. Uff C, Frith D, Harrison C, Powell M, Kitchen N. Sir Victor Horsley's 19th century operations at the National Hospital for Neurology and Neurosurgery, Queen Square. J Neurosurg. 2011; 114:534–42.
2. Stevanovic A, Rossaint R, Veldeman M, Bilotta F, Coburn M. Anaesthesia management for awake craniotomy: systematic review and meta-analysis. PLoS One. 2016; 11:e0156448.
3. Gerritsen JKW, Arends L, Klimek M, Dirven CMF, Vincent AJE. Impact of intraoperative stimulation mapping on high-grade glioma surgery outcome: a meta-analysis. Acta Neurochir (Wien). 2019; 161:99–107.
4. Eseonu CI, Rincon-Torroella J, ReFaey K, Lee YM, Nangiana J, Vivas-Buitrago T, et al. Awake craniotomy vs craniotomy under general anesthesia for perirolandic gliomas: evaluating perioperative complications and extent of resection. Neurosurgery. 2017; 81:481–9.
5. Meng L, Berger MS, Gelb AW. The potential benefits of awake craniotomy for brain tumor resection: an anesthesiologist's perspective. J Neurosurg Anesthesiol. 2015; 27:310–7.
6. Meng L, McDonagh DL, Berger MS, Gelb AW. Anesthesia for awake craniotomy: a how-to guide for the occasional practitioner. Can J Anaesth. 2017; 64:517–29.
7. Hervey-Jumper SL, Li J, Lau D, Molinaro AM, Perry DW, Meng L, et al. Awake craniotomy to maximize glioma resection: methods and technical nuances over a 27-year period. J Neurosurg. 2015; 123:325–39.
8. Rajan S, Cata JP, Nada E, Weil R, Pal R, Avitsian R. Asleep-awake-asleep craniotomy: a comparison with general anesthesia for resection of supratentorial tumors. J Clin Neurosci. 2013; 20:1068–73.
9. Bajwa SJ, Anand S, Kaur G. Anesthesia and cancer recurrences: the current knowledge and evidence. J Cancer Res Ther. 2015; 11:528–34.
10. Kim R. Effects of surgery and anesthetic choice on immunosuppression and cancer recurrence. J Transl Med. 2018; 16:8.
11. Meserve JR, Kaye AD, Prabhakar A, Urman RD. The role of analgesics in cancer propagation. Best Pract Res Clin Anaesthesiol. 2014; 28:139–51.
12. Brown T, Shah AH, Bregy A, Shah NH, Thambuswamy M, Barbarite E, et al. Awake craniotomy for brain tumor resection: the rule rather than the exception? J Neurosurg Anesthesiol. 2013; 25:240–7.
13. Richardson AM, McCarthy DJ, Sandhu J, Mayrand R, Guerrero C, Rosenberg C, et al. Predictors of successful discharge of patients on postoperative day 1 after craniotomy for brain tumor. World Neurosurg. 2019; 126:e869–77.
14. Ruis C, Wajer IH, Robe P, van Zandvoort M. Anxiety in the preoperative phase of awake brain tumor surgery. Clin Neurol Neurosurg. 2017; 157:7–10.
15. Potters JW, Klimek M. Awake craniotomy: improving the patient's experience. Curr Opin Anaesthesiol. 2015; 28:511–6.
16. Skucas AP, Artru AA. Anesthetic complications of awake craniotomies for epilepsy surgery. Anesth Analg. 2006; 102:882–7.
17. Eseonu CI, ReFaey K, Garcia O, John A, Quiñones-Hinojosa A, Tripathi P. Awake craniotomy anesthesia: a comparison of the monitored anesthesia care and asleep-awake-asleep techniques. World Neurosurg. 2017; 104:679–86.
18. Dilmen OK, Akcil EF, Oguz A, Vehid H, Tunali Y. Comparison of conscious sedation and asleep-awake-asleep techniques for awake craniotomy. J Clin Neurosci. 2017; 35:30–4.
19. Kulikov A, Lubnin A. Anesthesia for awake craniotomy. Curr Opin Anaesthesiol. 2018; 31:506–10.
20. Sewell D, Smith M. Awake craniotomy: anesthetic considerations based on outcome evidence. Curr Opin Anaesthesiol. 2019; 32:546–52.
21. Lobo F, Beiras A. Propofol and remifentanil effect-site concentrations estimated by pharmacokinetic simulation and bispectral index monitoring during craniotomy with intraoperative awakening for brain tumor resection. J Neurosurg Anesthesiol. 2007; 19:183–9.
22. Soehle M, Wolf CF, Priston MJ, Neuloh G, Bien CG, Hoeft A, et al. Propofol pharmacodynamics and bispectral index during key moments of awake craniotomy. J Neurosurg Anesthesiol. 2018; 30:32–8.
23. Lin N, Vutskits L, Bebawy JF, Gelb AW. Perspectives on dexmedetomidine use for neurosurgical patients. J Neurosurg Anesthesiol. 2019; 31:366–77.
24. Goettel N, Bharadwaj S, Venkatraghavan L, Mehta J, Bernstein M, Manninen PH. Dexmedetomidine vs propofol-remifentanil conscious sedation for awake craniotomy: a prospective randomized controlled trial. Br J Anaesth. 2016; 116:811–21.
25. McAuliffe N, Nicholson S, Rigamonti A, Hare GMT, Cusimano M, Garavaglia M, et al. Awake craniotomy using dexmedetomidine and scalp blocks: a retrospective cohort study. Can J Anaesth. 2018; 65:1129–37.
26. Garavaglia MM, Das S, Cusimano MD, Crescini C, Mazer CD, Hare GM, et al. Anesthetic approach to high-risk patients and prolonged awake craniotomy using dexmedetomidine and scalp block. J Neurosurg Anesthesiol. 2014; 26:226–33.
27. Rylova A, Maze M. Protecting the brain with xenon anesthesia for neurosurgical procedures. J Neurosurg Anesthesiol. 2019; 31:18–29.
28. Potters JW, Klimek M. Local anesthetics for brain tumor resection: current perspectives. Local Reg Anesth. 2018; 11:1–8.
29. Fontaine D, Almairac F. Pain during awake craniotomy for brain tumor resection. Incidence, causes, consequences and management. Neurochirurgie. 2017; 63:204–7.
30. Cormack J, Karna S. Macroglossia during awake craniotomy: a near miss. J Neurosurg Anesthesiol. 2018; 30:383–4.
31. Lee WK, Kim H, Bae MI, Choi SH, Min KT. Accidental intracerebral injection and seizure during scalp nerve blocks for awake craniotomy in a previously craniotomized patient- a case report. Korean J Anesthesiol. 2018; 71:483–5.
32. Spena G, Schucht P, Seidel K, Rutten GJ, Freyschlag CF, D'Agata F, et al. Brain tumors in eloquent areas: a European multicenter survey of intraoperative mapping techniques, intraoperative seizures occurrence, and antiepileptic drug prophylaxis. Neurosurg Rev. 2017; 40:287–98.
33. Spena G, Roca E, Guerrini F, Panciani PP, Stanzani L, Salmaggi A, et al. Risk factors for intraoperative stimulation-related seizures during awake surgery: an analysis of 109 consecutive patients. J Neurooncol. 2019; 145:295–300.
34. Chandra V, Rock AK, Opalak C, Stary JM, Sima AP, Carr M, et al. A systematic review of perioperative seizure prophylaxis during brain tumor resection: the case for a multicenter randomized clinical trial. Neurosurg Focus. 2017; 43:E18.
35. Pourzitaki C, Tsaousi G, Apostolidou E, Karakoulas K, Kouvelas D, Amaniti E. Efficacy and safety of prophylactic levetiracetam in supratentorial brain tumour surgery: a systematic review and meta-analysis. Br J Clin Pharmacol. 2016; 82:315–25.
36. Abdulrauf SI, Vuong P, Patel R, Sampath R, Ashour AM, Germany LM, et al. "Awake" clipping of cerebral aneurysms: report of initial series. J Neurosurg. 2017; 127:311–8.
37. Chan DYC, Chan DTM, Zhu CXL, Kan PKY, Ng AY, Hsieh YPS, et al. Awake craniotomy for excision of arteriovenous malformations? A qualitative comparison study with stereotactic radiosurgery. J Clin Neurosci. 2018; 51:52–6.
38. Duffau H. Is non-awake surgery for supratentorial adult low-grade glioma treatment still feasible? Neurosurg Rev. 2018; 41:133–9.
39. Ruis C. Monitoring cognition during awake brain surgery in adults: a systematic review. J Clin Exp Neuropsychol. 2018; 40:1081–104.
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