gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

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Is there a benefit of an awake-awake-awake craniotomy concerning intraoperative brainmapping compared to asleep-awake-asleep procedures? A prospective, clinical trial

Meeting Abstract

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  • C. Ott - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
  • C. Kerscher - Klinik für Anästhesiologie, Universitätsklinikum Regensburg
  • R. Luerding - Klinik und Poliklinik für Neurologie, Universitätsklinikum Regensburg
  • C. Doenitz - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
  • A. Brawanski - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
  • J. Schlaier - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocDO.10.09

doi: 10.3205/12dgnc099, urn:nbn:de:0183-12dgnc0990

Published: June 4, 2012

© 2012 Ott et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: In an awake craniotomy patients may be awake during the entire surgical period (awake-awake-awake craniotomy = AAAC), or they are initially sedated and will "wake up" only for brainmapping (asleep-awake-asleep craniotomy = SASC). The aim of our study was to investigate the influence of different anaesthesiological regimens on specific neuropsychological tests

Methods: 88 patients were investigated. In the first group 50 patients underwent AAAC for brain tumour surgery. Those patients were tested prior and during surgery. In the second group (total intravenous anaethesia regimen = TIVA, n = 20) and the third group (regional anesthesia with sedation = RAS, n = 18) neuropsychological tests were performed prior and 15 min and 30 min after the sedation. We have deliberately chosen not to examine neurosurgical patients in the RAS and TIVA group, as we wanted to exclude a bias caused by perioperative neurological deficits. Tests included MWT-B-Test (Mehrfachwahl-Wortschatz-Intelligenztest), DO40 (a shortened DO80 test, which is usually used for brainmapping of the speech center), Rows of numbers, modified Regensburg Wordfluency Test (RWT) and Finger-Tapping. Informed consent was obtained by all patients.

Results: In the AAAC-group no differences between preoperative and intraoperative test results were found. In the TIVA and RAS group subjects had deteriorated in all postop. tests compared to preop. condition, except D040 preop. vs. 2nd postop. test in the RAS group (p < 0,05 in most of the tests). Patients improved in all tests between the 1st and 2nd postop. testing period (p < 0,05 in most of the tests).

Conclusions: In the TIVA and RAS group alertness, word fluency and motor performance are significantly influenced by the prior sedation up to half an hour after surgery. The DO40 also shows a deterioration (significant in the TIVA-group). In an SASC this could lead to a worsening of the neurooncological outcome of a patient. As most of the test results between the first and second postoperative testing period (TIVA and RAS) are significantly improving, one could assume that there is a change in the baselines caused by prior sedation, which could endanger the patients neurologic outcome in the case of a SASC. In our study the most reliable results are obtained with an AAAC.