Awake Surgery for Brain Vascular Malformations and Moyamoya Disease.

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Awake Surgery for Brain Vascular Malformations and Moyamoya Disease.

World Neurosurg. 2017 Apr 01;:

Authors: Aoun RJ, Sattur MG, Krishna C, Gupta A, Welz ME, Nanney AD, Koht AH, Tate MC, Noe KH, Sirven JI, Anderies BJ, Bolton PB, Trentman TL, Zimmerman RS, Swanson KR, Bendok BR

Abstract
OBJECTIVE: While a significant amount of experience has accumulated for awake procedures for brain tumor, epilepsy and carotid surgery, its utility for intracranial neurovascular indications remains largely undefined. Awake surgery, for select neurovascular cases, offers the advantage of precise brain mapping and robust neurological monitoring during surgery for lesions in eloquent areas, avoidance of potential hemodynamic instability, and possible faster recovery. Additionally, it opens the window for perilesional epileptogenic tissue resection with potentially less risk for iatrogenic injury.
METHODS: IRB approval was obtained for a retrospective review of awake surgeries for intracranial neurovascular indications over the past 36 months from a prospectively maintained quality database. We reviewed patients' clinical indications, clinical and imaging parameters, and postoperative outcomes.
RESULTS: 8 consecutive patients underwent 9 intracranial neurovascular awake procedures conducted by the senior author. A standardized "Sedated-Awake-Sedated" protocol was utilized in all eight patients. For the two AVM patients and the three cavernoma patients, awake brain surface and white matter mapping was performed before and during microsurgical resection. A neurological exam was obtained periodically throughout all 5 procedures. There were no intra-operative or peri-operative complications. Hypotension was avoided during the two Moyamoya revascularization procedures in the patient with a history of labile blood pressure. Postoperative imaging confirmed complete AVM and cavernoma resections. No new neurological deficits or new onset seizures were noted on 3-month follow-up.
CONCLUSION: Awake surgery appears to be safe for select patients with intracranial neurovascular pathologies. Potential advantages include greater safety, shorter length of stay and reduced cost.

PMID: 28377246 [PubMed - as supplied by publisher]

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