Our Summary

This research paper is about a study that evaluated the effectiveness of different anesthetic protocols used during awake craniotomy, a type of brain surgery where the patient is conscious. Awake craniotomy allows doctors to map the brain in real-time and remove tumors while preserving crucial brain functions.

The research involved reviewing multiple studies and trials involving awake craniotomy under Monitored Anesthesia Care (MAC). Various databases were used to gather data, and the researchers examined the impact of different anesthetic drugs on patient outcomes. They were particularly interested in the rate of neurological issues after surgery.

From 468 studies, 26 met the criteria for this review. The researchers found that about 23.7% of patients experienced some adverse events. A fraction of patients had neurological deficits (10.45%) and seizures (8.8%) after the operation.

Interestingly, the use of the anesthetic drug Remifentanil was linked with a lower risk of postoperative neurological deficits. Propofol was associated with a slightly lower rate of seizures during the operation, and Midazolam led to less agitation in patients.

However, the researchers found that the rate of secondary adverse outcomes, such as high blood pressure and brain tension, were below 10%, aligning with previous research findings.

In conclusion, the study suggests that Remifentanil, Propofol, and Midazolam may be more effective than other anesthetic drugs used during awake craniotomy. However, more research is needed to confirm these findings.

FAQs

  1. What is the purpose of using the awake craniotomy method in brain surgery?
  2. What were the key findings on the effectiveness of different anesthetic drugs during awake craniotomy?
  3. What percentage of patients experienced adverse events, neurological deficits, or seizures after awake craniotomy according to the research?

Doctor’s Tip

A helpful tip a doctor might tell a patient about craniotomy is to discuss the use of specific anesthetic drugs such as Remifentanil, Propofol, and Midazolam with their healthcare provider. These drugs may be more effective in reducing the risk of postoperative neurological deficits, seizures, and agitation during awake craniotomy surgery. It is important for patients to have open communication with their medical team to ensure the best possible outcome for their procedure.

Suitable For

Patients who are typically recommended for awake craniotomy include those with brain tumors located near critical brain regions responsible for speech, movement, or other important functions. Awake craniotomy is often performed for patients with gliomas, low-grade gliomas, and other brain tumors that are close to eloquent areas of the brain.

Additionally, awake craniotomy may be recommended for patients who require precise brain mapping to identify and preserve important functional areas of the brain. This includes patients with epilepsy, brain arteriovenous malformations, and other conditions that require precise surgical planning to avoid damage to essential brain structures.

Overall, awake craniotomy is recommended for patients who would benefit from real-time brain mapping and monitoring during surgery to minimize the risk of postoperative neurological deficits and other complications.

Timeline

Overall, the timeline of a patient’s experience before and after craniotomy may include:

  • Preoperative consultation and planning with the surgical team
  • Anesthetic induction and positioning on the operating table
  • Mapping and monitoring of brain functions during the surgery
  • Tumor removal or other procedures performed by the surgeon
  • Postoperative recovery in the hospital, including monitoring for any neurological deficits or complications
  • Follow-up appointments with the surgical team for further evaluation and care

After the craniotomy, the patient may experience some side effects or complications, such as headaches, nausea, or temporary changes in cognitive function. It is important for the patient to follow the postoperative care instructions provided by the medical team and attend all follow-up appointments to ensure a successful recovery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about craniotomy include:

  1. What is the purpose of awake craniotomy, and why is it being recommended for my specific case?
  2. What are the potential risks and complications associated with awake craniotomy?
  3. What type of anesthesia will be used during the procedure, and why was this choice made?
  4. How will my pain and discomfort be managed during and after the surgery?
  5. What steps will be taken to ensure my safety and comfort during awake craniotomy?
  6. How will my neurological function be monitored during the surgery, and what are the signs of potential complications?
  7. What is the expected recovery time and rehabilitation process following awake craniotomy?
  8. Are there any specific dietary or lifestyle changes I should make before or after the surgery to support my recovery?
  9. What follow-up appointments or tests will be necessary to monitor my progress after the surgery?
  10. Are there any alternative treatment options to consider, and what are the potential benefits and risks of each option?

Reference

Authors: Aghajanian S, Naeimi A, Mohammadifard F, Mohammadi I, Rajai Firouzabadi S, Baradaran Bagheri A, Khorasanizadeh M, Elsamadicy AA. Journal: Neurosurg Rev. 2025 Jan 16;48(1):57. doi: 10.1007/s10143-025-03176-y. PMID: 39815114