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Positions in neurosurgery
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
Zilvinas Zakarevicius, Mikhail Gelfenbeyn, Irene Rozet
With the development of the functional neurosurgery, awake craniotomy is becoming more popular, where the patient is either awake throughout the procedure or can be woken up during the surgery. It is commonly done for functional neurosurgery such as in epilepsy surgeries, or in implantation of deep brain stimulators (e.g., in Parkinson’s disease). The neurological assessment in the awake patient is essential.
Cranial Neurosurgery
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Low-grade gliomas (WHO grade II) have a peak incidence in the fourth decade of life, and commonly present with seizures initially. Where tumours encroach on eloquent cortex, especially the speech areas of the dominant hemisphere, awake craniotomy allows mapping of function with surface electrodes at operation, to limit resection and minimise postoperative deficit. High-grade gliomas include anaplastic astrocytoma (WHO grade III) and glioblastoma (WHO grade IV), the commonest glial tumour (Figure43.23). They typically present de novo with peak incidence in the fifth and sixth decades of life, respectively, or they may represent transformation of previously diagnosed, or clinically silent, low-grade gliomas. Active treatment consists of maximal resection, high-dose focused radiation therapy, and chemotherapy administered locally as carmustine wafers at the time of resection and/or systemically with oral temozolomide. Median survival for glioblastoma remains just over 12 months.
Neurosurgery
Published in Brian J Pollard, Gareth Kitchen, Handbook of Clinical Anaesthesia, 2017
The key principal of an awake craniotomy is that the patient is either awake or lightly sedated during the tumour excision. The patient can be asleep for the craniotomy preparation stage and the closure; this is known as the asleep, awake, asleep technique where usually a laryngeal mask airway is used to maintain the airway. The choice of technique will be determined by the surgeon, pathology, length of surgery and patient factors. The essential anaesthesia requirements are
Scalp block for awake craniotomy: Lidocaine-bupivacaine versus lidocaine-bupivacaine with adjuvants
Published in Egyptian Journal of Anaesthesia, 2020
Yasser M. Nasr, Salwa H. Waly, Ahmed A. Morsy
Awake craniotomy can be defined as a sort of craniotomy in which the patient is conscious and responsive at any time during the procedure [3]. It might be performed under one of three different forms of anesthetic care. Sleep–awake–sleep technique is based upon anesthetizing the patient during skull-pin head holder, and then consciousness must be regained during brain mapping of cortical areas. Another technique might be performing monitored anesthetic care with the patient mildly sedated all through the procedure. Lastly, the awake all-through technique in which no sedation is provided. It only requires analgesia and special attention to non-pharmacological interventions such as hypnosis [4]. Local anesthesia is the cornerstone in awake craniotomy surgeries [5–7]. In awake all-through technique, effective local anesthetics is mandatory [3].
Awake craniotomy for assisting placement of auditory brainstem implant in NF2 patients
Published in Acta Oto-Laryngologica, 2018
Qiangyi Zhou, Zhijun Yang, Zhenmin Wang, Bo Wang, Xingchao Wang, Chi Zhao, Shun Zhang, Tao Wu, Peng Li, Shiwei Li, Fu Zhao, Pinan Liu
In the present study, awake craniotomy was applied in NF2 patients during ABI surgery. Satisfactory numbers of effective electrodes, threshold levels and distinct pitches were achieved in the wake-up hearing test. We demonstrated that awake craniotomy for ABI placement is safe and well tolerated, no obvious extra surgical risk was found due to the awake craniotomy. This method can potentially improve the localization accuracy of the cochlear nucleus during surgery. In addition, this is the only published study in Mandarin-speaking Chinese NF2 patients with ABIs. Open speech understanding is improved with the combination of ABI and lip reading in our series. More research is needed to investigate the potential benefits of awake craniotomy and improve ABI speech-processing strategies for tonal languages.
The benefits of perioperative music interventions for patients undergoing neurosurgery: a mixed-methods systematic review
Published in British Journal of Neurosurgery, 2022
Koy Chong Ng Kee Kwong, Chun Xien Kang, Chandrasekaran Kaliaperumal
In our review, music intervention was associated with significantly reduced anxiety in most studies, with a trend towards decreased pain also being observed. Quantitative findings were generally consistent with our qualitative analysis which revealed multiple instances where music intervention helped to alleviate anxiety and pain in participants. Music intervention was, however, not always positively viewed by participants, who cited reasons such as reduced time spent with their loved ones and post-operative headaches. Mixed evidence was obtained for other quality of life measures such as depression, mood and stress. A significant decrease in physiological parameters was only apparent in one study involving awake craniotomy patients.