Anaesthetic management of awake craniotomy for tumour resection.
BACKGROUND
Awake craniotomy allows accurate localisation of the eloquent brain, which is crucial during brain tumour resection in order to minimise risk of neurologic injury. The role of the anaesthesiologist is to provide adequate analgesia and sedation while maintaining ventilation and haemodynamic stability in an awake patient who needs to be cooperative during neurological testing. We reviewed the anaesthetic management of patients undergoing an awake craniotomy procedure.


METHODS
The records of all the patients who had an awake craniotomy at our institution from July 2004 till June 2006 were reviewed. The anaesthesia techniques and management were examined. The perioperative complications and the outcome of the patients were noted.


RESULTS
There were 17 procedures carried out during the study period. Local anaesthesia with moderate to deep sedation was the technique used in all the patients. Respiratory complications occurred in 24% of the patients. Hypertension was observed in 24% of the patients. All the complications were transient and easily treated. During cortical stimulation, motor function was assessed in 16 patients (94%). Three patients (16%) had lesions in the temporal-parietal region and speech was assessed intraoperatively. Postoperative motor weakness was seen in 1 patient despite uneventful intraoperative testing. No patient required intensive care unit stay. The median length of stay in the high dependency unit was 1 day and the median length of hospital stay was 9 days. There was no in-hospital mortality.


CONCLUSIONS
Awake craniotomy for brain tumour excision can be successfully performed under good anaesthetic conditions with careful titration of sedation. Our series showed it to be a well-tolerated procedure with a low rate of complications. The benefits of maximal tumour excision can be achieved, leading to potentially better patient outcome.
See
Jee-Jian
JJ
Department of Anaesthesiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433. jee_jian_see@ttsh.com.sg
Lew
Thomas W K
TW
Kwek
Tong-Kiat
TK
Chin
Ki-Jinn
KJ
Wong
Mary F M
MF
Liew
Qui-Yin
QY
Lim
Siew-Hoon
SH
Ho
Hwee-Shih
HS
Chan
Yeow
Y
Loke
Genevieve P Y
GP
Yeo
Vincent S T
VS
D000328:Adult; D000368:Aged; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D001932:Brain Neoplasms / Q000601:surgery*; D016292:Procedural Sedation; D003399:Craniotomy; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D019990:Perioperative Care; D012846:Singapore
D000779:Anesthetics, Local