Simplifying the Technique of Awake Brain Surgery in a Condition of Less Equipped Neurosurgical Institution in Uzbekistan

Overview

Journal Asian J Neurosurg

Specialty Neurology

Date 2023 Dec 28

PMID 38152531

Authors

Dilshod Mukhammadvalievich Mamadaliev

Gayrat Maratovich Kariev

Ulugbek Maksudovich Asadullaev

Jakhongir Bakhodirovich Yakubov

Kamoliddin Sodikjonovich Zokirov

Khabibullo Abdukholikovich Khasanov

Tokhir Makhmudovich Akhmediev

Dmitriy Sergeyevich Korotkov

Affiliations

Soon will be listed here.

Abstract

Currently, awake craniotomy (AC) is one of the most often employed procedures to map and resect tumors in eloquent brain areas, avoiding the use of general anesthesia (GA) and thereby reducing anesthesia-related complications and cost of surgery. Resource limitations are one of the basic reasons for avoiding AC in low- and middle-income countries (LMICs). The aim of this study is to describe the simplified protocol of awake brain surgery that can be implemented in a limited financial setting in LMICs and to share our first experience. Twenty-five patients diagnosed with tumor of the left frontotemporal lobes, all involving Broca's and Wernicke's areas, were operated on using AC. Brain mapping was executed using mono- and bipolar direct electrical stimulation including cortical and subcortical (axonal) mapping profiles, investigating basically cortical language centers. Neither neuronavigation nor intraoperative magnetic resonance imaging (MRI) was utilized due to financial constraints. AC was performed successfully in 23 of 25 patients, achieving a near-total resection in 16 (69.5%) patients, subtotal resection in 4 patients (17.39%) patients, and partial resection in 3 (13.04%) patients. In two patients, due to psychological instability-agitation and fear during the awake phase-speech test was not technically possible, so they were reintubated by giving them GA. There was no mortality in the early or postoperative period. In spite of the absence of advanced pre- and intraoperative technologies such as intraoperative MRI and navigation systems, AC can be safely performed in LMICs. These tools along with intraoperative cortical mapping and language testing can guarantee better surgical outcomes and quality of life. However, our study confirms that omitting these tools does not make a huge difference in getting good results with AC and that AC is not absolutely impossible. AC can be performed successfully, preserving eloquent brain areas, with minimum and basic set of the armamentarium like system for cortical and subcortical intraoperative neurostimulation which provides cortical/subcortical brain mapping.

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References

Motomura K, Fujii M, Maesawa S, Kuramitsu S, Natsume A, Wakabayashi T . Association of dorsal inferior frontooccipital fasciculus fibers in the deep parietal lobe with both reading and writing processes: a brain mapping study. J Neurosurg. 2014; 121(1):142-8. DOI: 10.3171/2014.2.JNS131234. View

Joswig H, Bratelj D, Brunner T, Jacomet A, Hildebrandt G, Surbeck W . Awake Craniotomy: First-Year Experiences and Patient Perception. World Neurosurg. 2016; 90:588-596.e2. DOI: 10.1016/j.wneu.2016.02.051. View

Shen E, Calandra C, Geralemou S, Page C, Davis R, Andraous W . The Stony Brook awake craniotomy protocol: A technical note. J Clin Neurosci. 2019; 67:221-225. DOI: 10.1016/j.jocn.2019.06.042. View

July J, Manninen P, Lai J, Yao Z, Bernstein M . The history of awake craniotomy for brain tumor and its spread into Asia. Surg Neurol. 2008; 71(5):621-4. DOI: 10.1016/j.surneu.2007.12.022. View

Bonhomme V, Franssen C, Hans P . Awake craniotomy. Eur J Anaesthesiol. 2009; 26(11):906-12. DOI: 10.1097/EJA.0b013e32833000c5. View

Ojemann G, Mateer C . Human language cortex: localization of memory, syntax, and sequential motor-phoneme identification systems. Science. 1979; 205(4413):1401-3. DOI: 10.1126/science.472757. View

Taylor M, Bernstein M . Awake craniotomy with brain mapping as the routine surgical approach to treating patients with supratentorial intraaxial tumors: a prospective trial of 200 cases. J Neurosurg. 1999; 90(1):35-41. DOI: 10.3171/jns.1999.90.1.0035. View

Motomura K, Terasawa Y, Natsume A, Iijima K, Chalise L, Sugiura J . Anterior insular cortex stimulation and its effects on emotion recognition. Brain Struct Funct. 2019; 224(6):2167-2181. DOI: 10.1007/s00429-019-01895-9. View

Matsumae M, Nishiyama J, Kuroda K . Intraoperative MR Imaging during Glioma Resection. Magn Reson Med Sci. 2021; 21(1):148-167. PMC: 9199972. DOI: 10.2463/mrms.rev.2021-0116. View

10.

Axelson H, Latini F, Jemstedt M, Ryttlefors M, Zetterling M . Continuous subcortical language mapping in awake glioma surgery. Front Oncol. 2022; 12:947119. PMC: 9416475. DOI: 10.3389/fonc.2022.947119. View

11.

Danks R, Rogers M, Aglio L, Gugino L, Black P . Patient tolerance of craniotomy performed with the patient under local anesthesia and monitored conscious sedation. Neurosurgery. 1998; 42(1):28-34; discussion 34-6. DOI: 10.1097/00006123-199801000-00006. View

12.

Mofatteh M, Mashayekhi M, Arfaie S, Adeleye A, Jolayemi E, Ghomsi N . Awake Craniotomy in Africa: A Scoping Review of Literature and Proposed Solutions to Tackle Challenges. Neurosurgery. 2023; 93(2):274-291. PMC: 10319364. DOI: 10.1227/neu.0000000000002453. View

13.

Bukhari S, Shamim M . Can awake glioma surgery be the new standard of care in developing countries?. Surg Neurol Int. 2020; 11:434. PMC: 7749937. DOI: 10.25259/SNI_635_2020. View

14.

Motomura K, Chalise L, Ohka F, Aoki K, Tanahashi K, Hirano M . Impact of the extent of resection on the survival of patients with grade II and III gliomas using awake brain mapping. J Neurooncol. 2021; 153(2):361-372. DOI: 10.1007/s11060-021-03776-w. View

15.

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7):e1000097. PMC: 2707599. DOI: 10.1371/journal.pmed.1000097. View

16.

Abdelhameed E, Abdelghany M, Abdelkhalek H, Elatrozy H . Awake surgery for lesions near eloquent brain under scalp block and clinical monitoring: experience of single center with limited resources. Egypt J Neurol Psychiatr Neurosurg. 2021; 57(1):78. PMC: 8205193. DOI: 10.1186/s41983-021-00333-0. View

17.

Wan Hassan W . The history of awake craniotomy in hospital universiti sains malaysia. Malays J Med Sci. 2014; 20(5):67-9. PMC: 3957358. View

18.

Duffau H, Gatignol P, Mandonnet E, Peruzzi P, Tzourio-Mazoyer N, Capelle L . New insights into the anatomo-functional connectivity of the semantic system: a study using cortico-subcortical electrostimulations. Brain. 2005; 128(Pt 4):797-810. DOI: 10.1093/brain/awh423. View

19.

Kayama T . The guidelines for awake craniotomy guidelines committee of the Japan awake surgery conference. Neurol Med Chir (Tokyo). 2012; 52(3):119-41. DOI: 10.2176/nmc.52.119. View

20.

Whittle I, Midgley S, Georges H, Pringle A, Taylor R . Patient perceptions of "awake" brain tumour surgery. Acta Neurochir (Wien). 2005; 147(3):275-7. DOI: 10.1007/s00701-004-0445-7. View