Awake Craniotomy the future of Neurosurgery
18th International Conference on Neurology and Neurological Disorders
August 23-24, 2018 | Paris, France
Debabrata Mukhopadhyay, Anil Gurnani and Asha Bakshi
Kailash Health care, India
Posters & Accepted Abstracts : J Neurol Neurorehabil Res
Abstract:
Introduction: Surgical treatment of intrinsic brain tumour in the
eloquent areas like speech or motor is always a risk factor for
major deficit. Awake craniotomy is a useful surgical approach to
identify and preserve functional areas in brain and maximizes
tumour removal. The other advantages are very short hospital
stay, bypassing general anaesthesia, therefore lesser risks
and cost effective. These advantages of awake craniotomy is
encouraging to operate on all intraxial supratentorial tumours
irrespective of eloquent areas in the brain.
Methods: Retrospective analysis was done with selected
patients admitted from July 2011 to February 2018 for awake
craniotomy. Patient presentations, co morbid conditions,
tumour locations and the histopathological features were
documented. The presentation was seizure and/ progressive
neurological deficit. Long acting local anaesthesia was used
for scalp block. Anaesthesia was performed in a state of
sleep-awake-sleep pattern, keeping patients fully awake
during tumour removal. The brain eloquent functions were
closely monitored whenever tumours were in eloquent areas
of brain clinically during surgery. However, unlike routine,
brain mapping was not performed due to lack of resources.
Results: A total of 55 patients were included in the study of age
between 24-55 years (mean 36). 31 (56.36 %) were females
and 24(43.63 %) males.31(56.36%) patients presented with
predominantly seizure disorders and rest with progressive
neurological deficit. 47 (85.45%) patients were discharged on
second post-operative day. Complications was encountered in 6
(10.90 %) patients who developed brain swelling intraoperatively
and 8(14.54 %) deteriorated neurologically in the immediate
post-operative period however managed successfully.
Patients with prior neurological deficit only deteriorated. No
complications were encountered who was neurologically intact.
8(14.28%) patients require ICU/ HDU care for different reasons.
There was no mortality during the hospital stay. Histopathology
revealed 39 (70.90 %) patients low grade glioma, 13 (23.63%)
high grade glioma and 3 (5.45%) metastases.
Conclusion: Awake Craniotomy is a safe surgical management
for intrinsic brain tumours irrespective of eloquent area of
brain although surgery and anaesthesia is a challenge. It
offers great advantage towards disease outcome.
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