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allied
academies
Nov12-13, 2018 | Paris, France
Central Nervous System & Therapeutics
International Conference on
Journal of Neurology and Neurorehabilitation Research | Volume 3
Awake Craniotomy the future of Neurosurgery
Debabrata Mukhopadhyay
and
Asha Bakshi
Kailash Health care, India
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.
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, brainmapping
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 postoperative day. Complications was encountered
in 6 (10.90 %) patients who developed brain swelling
intraoperatively and 8(14.54%) deteriorated neurologically
in the immediate postoperative 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. Therewas nomortality during the hospital
stay. Histopathology revealed 39 (70.90%) patients low grade
glioma,13(23.63%)highgradegliomaand3(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.
e:
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