title: [Incidence and causes of early end in awake surgery for language mapping not directly related to eloquence].
abstract: The incidence and causes that may lead to an early end (unfinished cortical/subcortical mapping) of awake surgery for language mapping are little known. A study was conducted on 41 patients with brain glioma located in the language area that had awake surgery under conscious sedation. Surgery was ended early in 6 patients. The causes were: tonic-clonic seizure (1), lack of cooperation due to fatigue/sleep (4), whether or not word articulation was involved, a decreased level of consciousness for ammonia encephalopathy that required endotracheal intubation (1). There are causes that could be expected and in some cases avoided. Tumour size, preoperative aphasia, valproate treatment, and type of anaesthesia used are variables to consider to avoid failure in awake surgery for language mapping. With these results, the following measures are proposed: l) If the tumour is large, perform surgery in two times to avoid fatigue, 2) if patient has a preoperative aphasia, do not use sedation during surgery to ensure that sleepiness does not cause worse word articulation, 3) if the patient is on valproate treatment, it is necessary to rule out the pre-operative symptoms that are not due to ammonia encephalopathy.
authors.affiliation: Servicio de Neurocirugía, Hospital del Mar, Barcelona, España. Electronic address: Gloriavillalbamartinez@gmail.com.
authors.forename: Gloria
authors.initials: G
authors.lastname: Villalba
authors.affiliation: Servicio de Anestesia y Reanimación, Hospital del Mar, Barcelona, España.
authors.forename: Susana
authors.initials: S
authors.lastname: Pacreu
authors.affiliation: Servicio de Anestesia y Reanimación, Hospital del Mar, Barcelona, España.
authors.forename: Juan Luis
authors.initials: JL
authors.lastname: Fernández-Candil
authors.affiliation: Servicio de Neurología, Hospital del Mar, Barcelona, España.
authors.forename: Alba
authors.initials: A
authors.lastname: León
authors.affiliation: Servicio de Neurocirugía, Hospital del Mar, Barcelona, España.
authors.forename: Laura
authors.initials: L
authors.lastname: Serrano
authors.affiliation: Servicio de Neurocirugía, Hospital del Mar, Barcelona, España.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Conesa
mesh_terms: D001931:Brain Mapping; D001932:Brain Neoplasms / Q000601:surgery*; D005910:Glioma / Q000601:surgery*; D006801:Humans; D007802:Language; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D014851:Wakefulness
keywords: Afasia; Aphasia; Awake surgery; Brain glioma; Conscious sedation; Craneotomía con paciente despierto; Eloquence area; Glioma cerebral; Language mapping; Mapeo lenguaje; Sedación consciente; Área elocuente