Our Summary

This research paper reviews the use of awake craniotomy (a surgery where the patient is awake while doctors operate on their brain) and intraoperative brain mapping (a technique used during surgery to identify important areas of the brain) for preserving executive functions (EF) – these are brain processes that help us plan, focus attention, remember instructions, and juggle multiple tasks. Traditionally, this method is used to preserve language, vision, and motor functions, but not often for EF.

The authors reviewed 13 studies that assessed EF during surgery in 351 patients. They checked how well the surgery was done, how the patients’ EF and overall brain function were after the surgery, and whether there were any side effects.

They found that the most common method used was the awake-asleep-awake protocol where the patient is awake for part of the surgery, sedated for another part, and then awakened again. The doctors monitored brain function using various tests during the surgery.

The results showed that patients who had their EF mapped during surgery had similar or even better outcomes in terms of how much of the lesion could be removed. Moreover, these patients had significantly better preservation of their EF compared to those who didn’t have EF mapping.

The authors concluded that awake craniotomy with EF mapping is a safe and effective technique that can lead to better brain function outcomes with minimal side effects, with the most common being easily controlled seizures during the operation.

FAQs

  1. What is the purpose of awake craniotomy and intraoperative brain mapping?
  2. What are the findings of the study about the use of awake craniotomy with EF mapping?
  3. What are the potential side effects of the awake craniotomy with EF mapping?

Doctor’s Tip

One helpful tip a doctor might tell a patient undergoing a craniotomy is to discuss the possibility of awake craniotomy with EF mapping with their surgical team. This technique can help preserve important brain functions such as executive functions, which are essential for daily tasks and quality of life. By discussing this option with their medical team, patients can ensure they are receiving the most personalized and effective treatment for their specific needs.

Suitable For

Patients who are typically recommended for a craniotomy with awake mapping of executive functions are those with brain lesions or tumors located in areas of the brain that are responsible for EF. These patients may be experiencing symptoms such as difficulty with planning, organization, decision-making, or cognitive flexibility. Additionally, patients who have not responded well to other treatments or who have tumors in critical areas of the brain that need to be removed while preserving important cognitive functions may also be recommended for this type of surgery. Additionally, patients who are willing and able to cooperate during the awake portion of the surgery and who do not have any contraindications for this type of procedure may be good candidates for awake craniotomy with EF mapping.

Timeline

Before the craniotomy:

  • Patient undergoes pre-operative evaluations and tests to determine the need for surgery
  • Patient meets with their surgical team to discuss the procedure and potential risks
  • Patient may undergo imaging scans such as MRI or CT to help plan the surgery
  • Patient may be instructed to stop taking certain medications before the surgery
  • Patient is prepared for the surgery with fasting and pre-operative instructions

During the craniotomy:

  • Patient is brought into the operating room and prepared for surgery
  • Anesthesia is administered to the patient
  • Surgeons perform the craniotomy, removing a portion of the skull to access the brain
  • Intraoperative brain mapping is used to identify important brain areas
  • Awake-asleep-awake protocol may be used, with the patient awake for part of the surgery to monitor brain function
  • Surgeons remove the brain lesion or tumor while preserving important brain functions

After the craniotomy:

  • Patient is monitored in the recovery room for any immediate post-operative complications
  • Patient may stay in the hospital for a few days for observation and recovery
  • Patient is given instructions for post-operative care, including medication management and wound care
  • Patient may undergo follow-up imaging scans to monitor the brain healing process
  • Patient may be referred to rehabilitation services for physical or cognitive therapy if needed

What to Ask Your Doctor

  1. What are the potential benefits of undergoing an awake craniotomy with intraoperative brain mapping for preserving executive functions during surgery?
  2. What are the risks and potential side effects associated with awake craniotomy with intraoperative brain mapping?
  3. How will my executive functions be assessed during the surgery, and what measures will be taken to ensure their preservation?
  4. How experienced is the surgical team in performing awake craniotomy with intraoperative brain mapping for preserving executive functions?
  5. How will my overall brain function be monitored during the surgery, and what steps will be taken if any issues arise?
  6. What is the success rate of preserving executive functions with this technique, and what can I expect in terms of post-operative recovery and outcomes?
  7. Are there any alternative procedures or techniques that could be considered for preserving executive functions during the surgery?
  8. How long will the recovery process be following an awake craniotomy with intraoperative brain mapping, and what kind of rehabilitation or follow-up care will be necessary?
  9. What are the long-term implications and potential benefits of preserving executive functions during the surgery in terms of my overall quality of life and cognitive function?
  10. Are there any specific lifestyle changes or precautions I should take following the surgery to support the preservation of my executive functions?

Reference

Authors: Tariq R, Aziz HF, Paracha S, Ahmed N, Baqai MWS, Bakhshi SK, McAtee A, Ainger TJ, Mirza FA, Enam SA. Journal: Neurol Sci. 2024 Aug;45(8):3723-3735. doi: 10.1007/s10072-024-07475-y. Epub 2024 Mar 23. PMID: 38520640