Our Summary

This research paper talks about the challenges in performing awake craniotomy surgeries (brain surgeries where the patient is conscious) during the COVID-19 pandemic. These issues arise due to the need for special airway management and close contact with the medical team during the procedure. The researchers successfully performed the first awake craniotomy in the UK since the start of the pandemic lockdown. They reduced the patient’s hospital visits and used remote communication as much as possible. The existing protocol for this surgery was modified according to local and national guidelines. The surgery aimed to remove a brain tumor and was performed efficiently without compromising the safety of the patient or the medical staff. The outcome after the surgery was excellent. The researchers conclude that with necessary changes in the pre- and during-surgery protocols, awake craniotomy surgeries can be performed safely. By introducing new aspects to their technique, they suggest that this kind of surgery can be safely continued in selected patients.

FAQs

  1. How was the first awake craniotomy performed in the UK during the COVID-19 lockdown?
  2. What modifications were made to the existing awake craniotomy protocol to ensure safety during the pandemic?
  3. Can awake craniotomies with functional mapping be safely performed during the SARS-CoV-2 pandemic?

Doctor’s Tip

A helpful tip a doctor might tell a patient about craniotomy is to follow all pre-operative instructions provided by the medical team, such as fasting before surgery and avoiding certain medications. It is also important to discuss any concerns or questions with your healthcare provider before the procedure. Additionally, following post-operative care instructions, such as taking prescribed medications and attending follow-up appointments, is crucial for a successful recovery.

Suitable For

Patients who are typically recommended for craniotomy are those with brain tumors, epilepsy, arteriovenous malformations, aneurysms, traumatic brain injuries, and other conditions that require surgical intervention in the brain. Awake craniotomy may be recommended for patients who require functional mapping of the brain during surgery, such as those with tumors located in or near areas responsible for speech or movement. It is important to carefully select patients for awake craniotomy based on their medical history, overall health, and the specific goals of the surgery. In the context of the COVID-19 pandemic, additional precautions and modifications to protocols may be necessary to ensure the safety of both patients and healthcare staff during the procedure.

Timeline

  • Before craniotomy:
  1. Patient undergoes initial consultation and evaluation by neurosurgeon to determine need for surgery
  2. Pre-operative tests and imaging studies are conducted to plan surgery
  3. Patient may undergo psychological assessment to determine suitability for awake craniotomy
  4. Patient is educated about the procedure and given instructions for pre-operative preparation
  5. Patient may have a pre-operative appointment with anesthesiologist for discussion of anesthesia options
  • After craniotomy:
  1. Patient is monitored closely in the recovery room post-operatively
  2. Patient may be transferred to intensive care unit for further monitoring, depending on the complexity of the surgery
  3. Patient is gradually awakened from anesthesia and assessed for neurological function during the awake portion of the surgery
  4. Surgery is completed and patient is taken to the post-anesthesia care unit for further recovery
  5. Patient is monitored for any complications or side effects of surgery, such as infection or bleeding
  6. Patient is discharged from the hospital once stable and able to manage at home, with follow-up appointments scheduled for ongoing care and monitoring.

What to Ask Your Doctor

  1. Can you explain why a craniotomy is necessary in my case?
  2. What are the risks and potential complications associated with a craniotomy?
  3. What is the success rate of this procedure for my specific condition?
  4. Will I need to be awake during the craniotomy, and if so, why?
  5. How will my pain be managed during and after the procedure?
  6. How long is the recovery process expected to take?
  7. What kind of follow-up care will be needed after the craniotomy?
  8. Are there any alternative treatment options to consider?
  9. How will the COVID-19 pandemic impact the scheduling and safety of the procedure?
  10. What measures are being taken to ensure my safety and the safety of the medical team during the craniotomy?

Reference

Authors: Razak A, Sloan G, Sebastian J, Ehsan S, Karabatsou K. Journal: J Clin Neurosci. 2020 Dec;82(Pt A):49-51. doi: 10.1016/j.jocn.2020.10.048. Epub 2020 Oct 27. PMID: 33317738