Anesthesia Management for Awake Craniotomy: Report of Two Cases

Claudia Helena Ribeiro Da Silva; Luiz Eduardo Imbelloni; Isabella Cristina Ribeiro Andrade Starling; Flávia Marques de Melo; Marluce Marques de Souza

doi:doi:10.11648/j.crj.20221003.13

Anesthesia Management for Awake Craniotomy: Report of Two Cases

Claudia Helena Ribeiro Da Silva, Luiz Eduardo Imbelloni, Isabella Cristina Ribeiro Andrade Starling, Flávia Marques de Melo, Marluce Marques de Souza

Published in Cancer Research Journal (Volume 10, Issue 3)

Received: 5 July 2022 Accepted: 20 July 2022 Published: 5 August 2022

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Abstract

Introduction: Awake craniotomy (AC) started with epilepsy treatment and was extended to other procedures. Several techniques have been used successfully. We will describe show two cases successfully where using the technique with local anesthesia anestesia and sedation protocols were used successfully. Cases Information: The 1^st case is a male, 38 years old, 78 kg, ASA II classification, musician, previously healthy when he started with seizures. Imaging tests showed an expansive frontotemporal lesion on the left near the speech region, and tumor resection by awake craniotomy and with a speech monitoring technique in the perioperative period was indicated. At the time of resection, was allowed to play his guitar, with previously with asepsis and permission from the HICC, having been discharged from the ICU on the second day and to residency without neurological deficits. The 2^nd was a male patient, 22 years old, 63 kg, 170 cm, with neurofibromatosis with seizures and past thoracolumbar spine arthrodesis brought to operating room due to and tumor recurrence. An MRI of the skull was performed for postoperative control, showed tumor recurrence in an eloquent area, and surgical resection was indicated. After discussing the case with the patient, family members and the anesthetic team, it was decided to perform a craniotomy with the patient awake for better monitoring and safe delimitation of the resection area. The tumor resection was delimited by speech obtaining an almost total resection of the tumor. Conclusion: Based on the report from two cases, AC may have certain benefits for patients undergoing craniotomy, including shorter hospital stay, fewer neurological deficits, and shorter surgery time, with early discharge from the ICU and into residency with their families.

Published in	Cancer Research Journal (Volume 10, Issue 3)
DOI	10.11648/j.crj.20221003.13
Page(s)	70-74
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Neurosurgery, Awake Craniotomy, Ropivacaine, Lidocaine, Dextroketamine, Dexmedetomidine, Propofol

References

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[2]	July J, Manninen P, Lai J et al. The history of awake craniotomy for brain tumor and its spread into Asia. Surgical Neurology. 2009; 71: 621-625.
[3]	Stevanovic A, Rossaint R, Veldeman M et al. Anaesthesia management for awake craniotomy: Systematic review and meta-analysis. PLoS ONE, 2016; 11 (5): 1-44. doi: 10.1371/journal.pone.0156448.
[4]	Kim SH, Choi SH. Anesthetic considerations for awake craniotomy. Review. Anesth Pain Med. 2020; 15: 269-274.
[5]	Osborn I, Sebeo J. Scalp block during craniotomy: A classic technique revisited. J Neurosurg Anesthesiol. 2010; 22: 187-194.
[6]	Serletis D, Bernstein M. Prospective study of awake craniotomy used routinely and nonselectively for supratentorial tumors. Journal of Neurosurgery. 2007; 107 (1): 1-6.
[7]	Brown R, Shah AH, Bregy A et al. Awake craniotomy for brain tumor resection: The rule rather than the exception? Review Article. J Neurosurg Anesthesiol. 2013; 25: 240-247.
[8]	Elbakry AE, Ibrahim E. Propofol-dexmedetomidine versus propofol-remifentanil conscious sedation for awake craniotomy during epilepsy surgery. Minerva Anestesiol. 2017; 83: 1248-1254.
[9]	Goettel N, Bharadwaj S, Venkatraghavan L et al. Dexmedetomidine vs propofol remifentanil conscious sedation for awake craniotomy: a prospective randomized controlled trial. Br J Anaesth. 2016; 116 (6): 811-821.
[10]	Naaz S, Ozair E. Dexmedetomidine in current anaesthesia practice. A Review. J Clin Diagn Res. 2014; 8 (10): GE01-GE04.
[11]	Gottschalk A, Berkow LC, Stevens RD et al. Prospective evaluation of pain and analgesic use following major elective intracranial surgery. J Neurosurg. 2007; 106: 210-216.
[12]	Guilfoyle MR, Helmy A, Duane D, Hutchinson PJA. Regional scalp block for postcraniotomy analgesia: A systematic review and meta-analysis. Anesth Analg. 2013; 116: 1093-1102.

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Claudia Helena Ribeiro Da Silva, Luiz Eduardo Imbelloni, Isabella Cristina Ribeiro Andrade Starling, Flávia Marques de Melo, Marluce Marques de Souza. (2022). Anesthesia Management for Awake Craniotomy: Report of Two Cases. Cancer Research Journal, 10(3), 70-74. https://doi.org/10.11648/j.crj.20221003.13

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ACS Style

Claudia Helena Ribeiro Da Silva; Luiz Eduardo Imbelloni; Isabella Cristina Ribeiro Andrade Starling; Flávia Marques de Melo; Marluce Marques de Souza. Anesthesia Management for Awake Craniotomy: Report of Two Cases. Cancer Res. J. 2022, 10(3), 70-74. doi: 10.11648/j.crj.20221003.13

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AMA Style

Claudia Helena Ribeiro Da Silva, Luiz Eduardo Imbelloni, Isabella Cristina Ribeiro Andrade Starling, Flávia Marques de Melo, Marluce Marques de Souza. Anesthesia Management for Awake Craniotomy: Report of Two Cases. Cancer Res J. 2022;10(3):70-74. doi: 10.11648/j.crj.20221003.13

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@article{10.11648/j.crj.20221003.13,
  author = {Claudia Helena Ribeiro Da Silva and Luiz Eduardo Imbelloni and Isabella Cristina Ribeiro Andrade Starling and Flávia Marques de Melo and Marluce Marques de Souza},
  title = {Anesthesia Management for Awake Craniotomy: Report of Two Cases},
  journal = {Cancer Research Journal},
  volume = {10},
  number = {3},
  pages = {70-74},
  doi = {10.11648/j.crj.20221003.13},
  url = {https://doi.org/10.11648/j.crj.20221003.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.crj.20221003.13},
  abstract = {Introduction: Awake craniotomy (AC) started with epilepsy treatment and was extended to other procedures. Several techniques have been used successfully. We will describe show two cases successfully where using the technique with local anesthesia anestesia and sedation protocols were used successfully. Cases Information: The 1st case is a male, 38 years old, 78 kg, ASA II classification, musician, previously healthy when he started with seizures. Imaging tests showed an expansive frontotemporal lesion on the left near the speech region, and tumor resection by awake craniotomy and with a speech monitoring technique in the perioperative period was indicated. At the time of resection, was allowed to play his guitar, with previously with asepsis and permission from the HICC, having been discharged from the ICU on the second day and to residency without neurological deficits. The 2nd was a male patient, 22 years old, 63 kg, 170 cm, with neurofibromatosis with seizures and past thoracolumbar spine arthrodesis brought to operating room due to and tumor recurrence. An MRI of the skull was performed for postoperative control, showed tumor recurrence in an eloquent area, and surgical resection was indicated. After discussing the case with the patient, family members and the anesthetic team, it was decided to perform a craniotomy with the patient awake for better monitoring and safe delimitation of the resection area. The tumor resection was delimited by speech obtaining an almost total resection of the tumor. Conclusion: Based on the report from two cases, AC may have certain benefits for patients undergoing craniotomy, including shorter hospital stay, fewer neurological deficits, and shorter surgery time, with early discharge from the ICU and into residency with their families.},
 year = {2022}
}

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TY  - JOUR
T1  - Anesthesia Management for Awake Craniotomy: Report of Two Cases
AU  - Claudia Helena Ribeiro Da Silva
AU  - Luiz Eduardo Imbelloni
AU  - Isabella Cristina Ribeiro Andrade Starling
AU  - Flávia Marques de Melo
AU  - Marluce Marques de Souza
Y1  - 2022/08/05
PY  - 2022
N1  - https://doi.org/10.11648/j.crj.20221003.13
DO  - 10.11648/j.crj.20221003.13
T2  - Cancer Research Journal
JF  - Cancer Research Journal
JO  - Cancer Research Journal
SP  - 70
EP  - 74
PB  - Science Publishing Group
SN  - 2330-8214
UR  - https://doi.org/10.11648/j.crj.20221003.13
AB  - Introduction: Awake craniotomy (AC) started with epilepsy treatment and was extended to other procedures. Several techniques have been used successfully. We will describe show two cases successfully where using the technique with local anesthesia anestesia and sedation protocols were used successfully. Cases Information: The 1st case is a male, 38 years old, 78 kg, ASA II classification, musician, previously healthy when he started with seizures. Imaging tests showed an expansive frontotemporal lesion on the left near the speech region, and tumor resection by awake craniotomy and with a speech monitoring technique in the perioperative period was indicated. At the time of resection, was allowed to play his guitar, with previously with asepsis and permission from the HICC, having been discharged from the ICU on the second day and to residency without neurological deficits. The 2nd was a male patient, 22 years old, 63 kg, 170 cm, with neurofibromatosis with seizures and past thoracolumbar spine arthrodesis brought to operating room due to and tumor recurrence. An MRI of the skull was performed for postoperative control, showed tumor recurrence in an eloquent area, and surgical resection was indicated. After discussing the case with the patient, family members and the anesthetic team, it was decided to perform a craniotomy with the patient awake for better monitoring and safe delimitation of the resection area. The tumor resection was delimited by speech obtaining an almost total resection of the tumor. Conclusion: Based on the report from two cases, AC may have certain benefits for patients undergoing craniotomy, including shorter hospital stay, fewer neurological deficits, and shorter surgery time, with early discharge from the ICU and into residency with their families.
VL  - 10
IS  - 3
ER  -

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Author Information

Claudia Helena Ribeiro Da Silva

Health Sciences, Department of Anesthesiology, CET-SBA Hospital Felicio Rocho, Belo Horizonte, Brazil
Luiz Eduardo Imbelloni

Department of Anesthesiology, CET-SBA Hospital Clínicas Municipal de S?o Bernardo do Campo, S?o Paulo, Brazil
Isabella Cristina Ribeiro Andrade Starling

Department of Anesthesiology of Santa Casa, CET-SBA Hospital Felicio Rocho, Belo Horizonte, Brazil
Flávia Marques de Melo

Department of Anesthesiology of Santa Casa, CET-SBA Hospital Felicio Rocho, Belo Horizonte, Brazil
Marluce Marques de Souza

Department of Anesthesiology of Santa Casa, CET-SBA Hospital Felicio Rocho, Belo Horizonte, Brazil

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APA Style

Claudia Helena Ribeiro Da Silva, Luiz Eduardo Imbelloni, Isabella Cristina Ribeiro Andrade Starling, Flávia Marques de Melo, Marluce Marques de Souza. (2022). Anesthesia Management for Awake Craniotomy: Report of Two Cases. Cancer Research Journal, 10(3), 70-74. https://doi.org/10.11648/j.crj.20221003.13

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ACS Style

Claudia Helena Ribeiro Da Silva; Luiz Eduardo Imbelloni; Isabella Cristina Ribeiro Andrade Starling; Flávia Marques de Melo; Marluce Marques de Souza. Anesthesia Management for Awake Craniotomy: Report of Two Cases. Cancer Res. J. 2022, 10(3), 70-74. doi: 10.11648/j.crj.20221003.13

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AMA Style

Claudia Helena Ribeiro Da Silva, Luiz Eduardo Imbelloni, Isabella Cristina Ribeiro Andrade Starling, Flávia Marques de Melo, Marluce Marques de Souza. Anesthesia Management for Awake Craniotomy: Report of Two Cases. Cancer Res J. 2022;10(3):70-74. doi: 10.11648/j.crj.20221003.13

Copy | Download

@article{10.11648/j.crj.20221003.13,
  author = {Claudia Helena Ribeiro Da Silva and Luiz Eduardo Imbelloni and Isabella Cristina Ribeiro Andrade Starling and Flávia Marques de Melo and Marluce Marques de Souza},
  title = {Anesthesia Management for Awake Craniotomy: Report of Two Cases},
  journal = {Cancer Research Journal},
  volume = {10},
  number = {3},
  pages = {70-74},
  doi = {10.11648/j.crj.20221003.13},
  url = {https://doi.org/10.11648/j.crj.20221003.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.crj.20221003.13},
  abstract = {Introduction: Awake craniotomy (AC) started with epilepsy treatment and was extended to other procedures. Several techniques have been used successfully. We will describe show two cases successfully where using the technique with local anesthesia anestesia and sedation protocols were used successfully. Cases Information: The 1st case is a male, 38 years old, 78 kg, ASA II classification, musician, previously healthy when he started with seizures. Imaging tests showed an expansive frontotemporal lesion on the left near the speech region, and tumor resection by awake craniotomy and with a speech monitoring technique in the perioperative period was indicated. At the time of resection, was allowed to play his guitar, with previously with asepsis and permission from the HICC, having been discharged from the ICU on the second day and to residency without neurological deficits. The 2nd was a male patient, 22 years old, 63 kg, 170 cm, with neurofibromatosis with seizures and past thoracolumbar spine arthrodesis brought to operating room due to and tumor recurrence. An MRI of the skull was performed for postoperative control, showed tumor recurrence in an eloquent area, and surgical resection was indicated. After discussing the case with the patient, family members and the anesthetic team, it was decided to perform a craniotomy with the patient awake for better monitoring and safe delimitation of the resection area. The tumor resection was delimited by speech obtaining an almost total resection of the tumor. Conclusion: Based on the report from two cases, AC may have certain benefits for patients undergoing craniotomy, including shorter hospital stay, fewer neurological deficits, and shorter surgery time, with early discharge from the ICU and into residency with their families.},
 year = {2022}
}

Copy | Download

TY  - JOUR
T1  - Anesthesia Management for Awake Craniotomy: Report of Two Cases
AU  - Claudia Helena Ribeiro Da Silva
AU  - Luiz Eduardo Imbelloni
AU  - Isabella Cristina Ribeiro Andrade Starling
AU  - Flávia Marques de Melo
AU  - Marluce Marques de Souza
Y1  - 2022/08/05
PY  - 2022
N1  - https://doi.org/10.11648/j.crj.20221003.13
DO  - 10.11648/j.crj.20221003.13
T2  - Cancer Research Journal
JF  - Cancer Research Journal
JO  - Cancer Research Journal
SP  - 70
EP  - 74
PB  - Science Publishing Group
SN  - 2330-8214
UR  - https://doi.org/10.11648/j.crj.20221003.13
AB  - Introduction: Awake craniotomy (AC) started with epilepsy treatment and was extended to other procedures. Several techniques have been used successfully. We will describe show two cases successfully where using the technique with local anesthesia anestesia and sedation protocols were used successfully. Cases Information: The 1st case is a male, 38 years old, 78 kg, ASA II classification, musician, previously healthy when he started with seizures. Imaging tests showed an expansive frontotemporal lesion on the left near the speech region, and tumor resection by awake craniotomy and with a speech monitoring technique in the perioperative period was indicated. At the time of resection, was allowed to play his guitar, with previously with asepsis and permission from the HICC, having been discharged from the ICU on the second day and to residency without neurological deficits. The 2nd was a male patient, 22 years old, 63 kg, 170 cm, with neurofibromatosis with seizures and past thoracolumbar spine arthrodesis brought to operating room due to and tumor recurrence. An MRI of the skull was performed for postoperative control, showed tumor recurrence in an eloquent area, and surgical resection was indicated. After discussing the case with the patient, family members and the anesthetic team, it was decided to perform a craniotomy with the patient awake for better monitoring and safe delimitation of the resection area. The tumor resection was delimited by speech obtaining an almost total resection of the tumor. Conclusion: Based on the report from two cases, AC may have certain benefits for patients undergoing craniotomy, including shorter hospital stay, fewer neurological deficits, and shorter surgery time, with early discharge from the ICU and into residency with their families.
VL  - 10
IS  - 3
ER  -

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