3 ms·

Isn't this standard practice for all brain surgery? Patient kept awake and active for feedback.

bookofjoe 7y ago
Retired neurosurgical anesthesiologist here. No, this is not standard practice for all brain surgery. Feedback from a conscious patient is not useful in most cases of tumor resection, nor is it employed in neurovascular procedures such as cerebral aneurysm clipping. Awake craniotomy is used in brain tumor resection when the mass encroaches on or borders crucial motor areas of the cerebral cortex, as was the case in the OP. A more frequent use case for this technique is in patients with intractable seizure disorders in whom partial temporal lobe resection is planned. Mapping the hyperactive areas with electrical stimulation applied by the neurosurgeon directly to brain tissue delineates pathological loci while minimizing resection of unaffected contiguous areas. A personal note: I very much enjoyed providing anesthesia for awake craniotomies. Everything about them required me to be at the very top of my game every second. For my preoperative visit on the evening before the procedure, to take a history and perform a physical examination, I made certain to make it clear to the patient and their family that I had all the time in the world, so that by the time I was finished, they were clear as to exactly what would happen, down to the questions I would be asking them when I woke them up from anesthesia with the top of their skull in a sterile tray and their brain exposed. There is an art to making someone about to undergo such a formidable procedure comfortable and able to get some sleep the night before surgery. I gave anesthesia for awake craniotomies perhaps 50-100 times over my 38 years of practice, the youngest patients being in their early teens.
- tomcam 7y ago
  This is why I love HN. Also his blog is endlessly fascinating: https://www.bookofjoe.com/ https://www.bookofjoe.com/

Retired neurosurgical anesthesiologist here. No, this is not standard practice for all brain surgery. Feedback from a conscious patient is not useful in most cases of tumor resection, nor is it employed in neurovascular procedures such as cerebral aneurysm clipping. Awake craniotomy is used in brain tumor resection when the mass encroaches on or borders crucial motor areas of the cerebral cortex, as was the case in the OP. A more frequent use case for this technique is in patients with intractable seizure disorders in whom partial temporal lobe resection is planned. Mapping the hyperactive areas with electrical stimulation applied by the neurosurgeon directly to brain tissue delineates pathological loci while minimizing resection of unaffected contiguous areas. A personal note: I very much enjoyed providing anesthesia for awake craniotomies. Everything about them required me to be at the very top of my game every second. For my preoperative visit on the evening before the procedure, to take a history and perform a physical examination, I made certain to make it clear to the patient and their family that I had all the time in the world, so that by the time I was finished, they were clear as to exactly what would happen, down to the questions I would be asking them when I woke them up from anesthesia with the top of their skull in a sterile tray and their brain exposed. There is an art to making someone about to undergo such a formidable procedure comfortable and able to get some sleep the night before surgery. I gave anesthesia for awake craniotomies perhaps 50-100 times over my 38 years of practice, the youngest patients being in their early teens.

tomcam 7y ago
This is why I love HN. Also his blog is endlessly fascinating: https://www.bookofjoe.com/ https://www.bookofjoe.com/