BACKGROUND The auditory brainstem implant(ABI)is a significant treatment to restore hearing sensations for neurofibromatosis type 2(NF2)patients.However,there is no ideal method in assisting the placement of ABIs.In t...BACKGROUND The auditory brainstem implant(ABI)is a significant treatment to restore hearing sensations for neurofibromatosis type 2(NF2)patients.However,there is no ideal method in assisting the placement of ABIs.In this case series,intraoperative cochlear nucleus mapping was performed in awake craniotomy to help guide the placement of the electrode array.CASE SUMMARY We applied the asleep-awake-asleep technique for awake craniotomy and hearing test via the retrosigmoid approach for acoustic neuroma resections and ABIs,using mechanical ventilation with a laryngeal mask during the asleep phases,utilizing a ropivacaine-based regional anesthesia,and sevoflurane combined with propofol/remifentanil as the sedative/analgesic agents in four NF2 patients.ABI electrode arrays were placed in the awake phase with successful intraoperative hearing tests in three patients.There was one uncooperative patient whose awake hearing test needed to be aborted.In all cases,tumor resection and ABI were performed safely.Satisfactory electrode effectiveness was achieved in awake ABI placement.CONCLUSION This case series suggests that awake craniotomy with an intraoperative hearing test for ABI placement is safe and well tolerated.Awake craniotomy is beneficial for improving the accuracy of ABI electrode placement and meanwhile reduces non-auditory side effects.展开更多
BACKGROUND Awake craniotomy has been widely used for tumor resection,epilepsy surgery,deep brain stimulation,and carotid endarterectomy.The report on awake artery malformation clipping is rare,especially for anesthesi...BACKGROUND Awake craniotomy has been widely used for tumor resection,epilepsy surgery,deep brain stimulation,and carotid endarterectomy.The report on awake artery malformation clipping is rare,especially for anesthesia management.CASE SUMMARY A 62-year-old female diagnosed with malformation of anterior cerebral artery at the right side.We clipped the artery malformation with intraoperative neuromonitoring(IONM)in awake craniotomy.Spontaneous respiration was maintained throughout the procedure by nasopharyngeal airway during the surgery successfully.CONCLUSION The technique of monitoring anesthesia care can be performed successfully for the patient with IONM.展开更多
Surgical excision is an important part of the multimodal therapy strategy for patients with glioblastoma,a very aggressive and invasive brain tumor.While major advances in surgical methods and technology have been acc...Surgical excision is an important part of the multimodal therapy strategy for patients with glioblastoma,a very aggressive and invasive brain tumor.While major advances in surgical methods and technology have been accomplished,numerous hurdles remain in the field of glioblastoma surgery.The purpose of this literature review is to offer a thorough overview of the current challenges in glioblastoma surgery.We reviewed the difficulties associated with tumor identification and visualization,resection extent,neurological function preservation,tumor margin evaluation,and inclusion of sophisticated imaging and navigation technology.Understanding and resolving these challenges is critical in order to improve surgical results and,ultimately,patient survival.展开更多
Background Successful treatment of gliomas in or adjacent to language areas constitutes a major challenge to neurosurgery. The present study was performed to evaluate the procedure of language mapping via intraoperati...Background Successful treatment of gliomas in or adjacent to language areas constitutes a major challenge to neurosurgery. The present study was performed to evaluate the procedure of language mapping via intraoperative direct cortical electrical stimulation under awake anaesthesia when performed prior to resective glioma surgery. Methods Thirty patients with gliomas and left-hemisphere dominance and, who underwent language mapping via intraoperative direct cortical electrical stimulation under awake anaesthesia before resective glioma surgery, were analyzed retrospectively. All patients had tumors in or adjacent to cortical language areas. The brain lesions were removed according to anatomic-functional boundaries with preservation of areas of language function. Both preoperative and postoperative functional findings were evaluated. Results Intraoperative language areas were detected in 20 patients but not in four patients. Language mapping failure for reasons attributable to the anaesthesia or to an intraoperative increase in intracranial pressure occurred in six cases. Seven patients presented with moderate or severe language deficits after six months of follow-up. Total resection was achieved in 14 cases, near-total resection in 12 cases and subtotal resection in four cases. Conclusions Intraoperative cortical electrical stimulation is an accurate and safe approach to identification of the language cortex. Awake craniotomy intraoperative cortical electrical stimulation, in combination with presurgical neurological functional imaging to identify the anatomic-functional boundaries of tumor resection, permits extensive tumor excision while preserving normal language function and minimizing the risk of postoperative language deficits.展开更多
基金Beijing Municipal Administration of Hospitals Ascent Plan,No.DFL20180502.
文摘BACKGROUND The auditory brainstem implant(ABI)is a significant treatment to restore hearing sensations for neurofibromatosis type 2(NF2)patients.However,there is no ideal method in assisting the placement of ABIs.In this case series,intraoperative cochlear nucleus mapping was performed in awake craniotomy to help guide the placement of the electrode array.CASE SUMMARY We applied the asleep-awake-asleep technique for awake craniotomy and hearing test via the retrosigmoid approach for acoustic neuroma resections and ABIs,using mechanical ventilation with a laryngeal mask during the asleep phases,utilizing a ropivacaine-based regional anesthesia,and sevoflurane combined with propofol/remifentanil as the sedative/analgesic agents in four NF2 patients.ABI electrode arrays were placed in the awake phase with successful intraoperative hearing tests in three patients.There was one uncooperative patient whose awake hearing test needed to be aborted.In all cases,tumor resection and ABI were performed safely.Satisfactory electrode effectiveness was achieved in awake ABI placement.CONCLUSION This case series suggests that awake craniotomy with an intraoperative hearing test for ABI placement is safe and well tolerated.Awake craniotomy is beneficial for improving the accuracy of ABI electrode placement and meanwhile reduces non-auditory side effects.
文摘BACKGROUND Awake craniotomy has been widely used for tumor resection,epilepsy surgery,deep brain stimulation,and carotid endarterectomy.The report on awake artery malformation clipping is rare,especially for anesthesia management.CASE SUMMARY A 62-year-old female diagnosed with malformation of anterior cerebral artery at the right side.We clipped the artery malformation with intraoperative neuromonitoring(IONM)in awake craniotomy.Spontaneous respiration was maintained throughout the procedure by nasopharyngeal airway during the surgery successfully.CONCLUSION The technique of monitoring anesthesia care can be performed successfully for the patient with IONM.
文摘Surgical excision is an important part of the multimodal therapy strategy for patients with glioblastoma,a very aggressive and invasive brain tumor.While major advances in surgical methods and technology have been accomplished,numerous hurdles remain in the field of glioblastoma surgery.The purpose of this literature review is to offer a thorough overview of the current challenges in glioblastoma surgery.We reviewed the difficulties associated with tumor identification and visualization,resection extent,neurological function preservation,tumor margin evaluation,and inclusion of sophisticated imaging and navigation technology.Understanding and resolving these challenges is critical in order to improve surgical results and,ultimately,patient survival.
文摘Background Successful treatment of gliomas in or adjacent to language areas constitutes a major challenge to neurosurgery. The present study was performed to evaluate the procedure of language mapping via intraoperative direct cortical electrical stimulation under awake anaesthesia when performed prior to resective glioma surgery. Methods Thirty patients with gliomas and left-hemisphere dominance and, who underwent language mapping via intraoperative direct cortical electrical stimulation under awake anaesthesia before resective glioma surgery, were analyzed retrospectively. All patients had tumors in or adjacent to cortical language areas. The brain lesions were removed according to anatomic-functional boundaries with preservation of areas of language function. Both preoperative and postoperative functional findings were evaluated. Results Intraoperative language areas were detected in 20 patients but not in four patients. Language mapping failure for reasons attributable to the anaesthesia or to an intraoperative increase in intracranial pressure occurred in six cases. Seven patients presented with moderate or severe language deficits after six months of follow-up. Total resection was achieved in 14 cases, near-total resection in 12 cases and subtotal resection in four cases. Conclusions Intraoperative cortical electrical stimulation is an accurate and safe approach to identification of the language cortex. Awake craniotomy intraoperative cortical electrical stimulation, in combination with presurgical neurological functional imaging to identify the anatomic-functional boundaries of tumor resection, permits extensive tumor excision while preserving normal language function and minimizing the risk of postoperative language deficits.
