Abstract
Some brain lesions, particularly epileptic and intrinsic brain tumors, can affect regions that are essential for cerebral functions. The resection of these lesions can only be performed with safety, in order not to cause a functional deficit, if the individual brain functional organization is understood. Several techniques are available to map brain functions, but direct electrical stimulation (cortical or subcortical) (DES) is gold-standard technique for the identification and preservation of eloquent cortical and subcortical structures during surgery. In this chapter, important aspects of awake neurosurgery are reviewed, with special attention to topographical and functional anatomy, anesthesiology, brain mapping techniques, electroneurophysiology, and intraoperative neurological and customized neuropsychological testing.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Axelson HW, Hesselager G, Flink R. Successful localization of the Broca area with short-train pulses instead of ‘Penfield’ stimulation. Seizure. 2009;18(5):374–5.
Hervey-Jumper et al. Awake craniotomy to maximize glioma resection: methods and technical nuances over a 27-year period. J Neurosurg. 2015;123(2):325–39. https://doi.org/10.3171/2014.10.JNS141520. Epub 2015 Apr 24.
Bello L, Fava M, Gallucci M, Giussani C, Carrabba G, Acerbi F, Songa V, Conte V, Baratta P, Stocchetti N, Papagno C. Intraoperative subcortical language tracts mapping guides surgical removal of Gliomas involving speech areas 902. Neurosurgery. 2006;59(2):488.
Coello, et al. Selection of intraoperative tasks for awake mapping based on relationships between tumor location and functional networks. J Neurosurg. 2013;119:1380–94.
De Benedictis A, Duffau H. Brain hodotopy: from esoteric concept to practical surgical applications. Neurosurgery. 2011;68(6):1703–23.
De Witte E, Satoer D, Colle H, Robert E, Visch-Brink E, Mariën P. Subcortical language and non-language mapping in awake brain surgery: the use of multimodal tests. Acta Neurochir. 2015;157(4):577–88.
Duffau H, editor. Brain mapping: from neural basis of cognition to surgical applications. Springer Science & Business Media. Vienna, Austria. 2011.
Duffau H, et al. Intraoperative mapping of the subcortical language pathways using direct stimulations. An anatomo-functional study. Brain. 2002;125(Pt 1):199–214.
FitzGerald DB, Cosgrove GR, Ronner S. Location of language in the cortex: a comparison between functional MR imaging and electrocortical stimulation. AJNR Am J Neuroradiol. 1997;18(8):1529–39.
Herrick IA, Craen RA, Gelb AW, McLachlan RS, Girvin JP, Parrent AG, et al. Propofol sedation during awake craniotomy for seizures: electrocorticographic and epileptogenic effects. Anesth Analg. 1997;84:1280–4.
Hervey-Jumper SL, Li J, Lau D, Molinaro AM, Perry DW, Meng L, Berger MS. Awake craniotomy to maximize glioma resection: methods and technical nuances over a 27-year period. J Neurosurg. 2015;123(2):325–39.
Huncke K, Van de Wiele B, Fried I, et al. The asleep-awake-asleep anesthetic technique for intraoperative language mapping. Neurosurgery. 1998;42:1312–6.
Ius T, Angelini E, Thiebaut de Schotten M, Mandonnet E, Duffau H. Evidence for potentials and limitations of brain plasticity using an atlas of functional resectability of WHO grade II gliomas: towards a “minimal common brain”. NeuroImage. 2011;56(3):992–1000. https://doi.org/10.1016/j.neuroimage.2011.03.022. Epub 2011 Mar 21
Mandonnet E, Winkler PA, Duffau H. Direct electrical stimulation as an input gate into brain functional networks: principles, advantages and limitations. Acta Neurochir. 2010;152(2):185–93.
Manninen PH, Balki M, Lukitto K, et al. Patient satisfaction with awake craniotomy for tumor surgery: a comparison of remifentanil and fentanyl in conjunction with propofol. Anesth Analg. 2006;102:237–42.
Ojemann G, Ojemann J, Lettich E, Berger M. Cortical language localization in left, dominant hemisphere. An electrical stimulation mapping investigation in 117 patients. J Neurosurg. 1989;71:316–26.
Ojemann GA. Individual variability in cortical localization of language. J Neurosurg. 1979;50(2):164–9.
Ojemann G, Ojemann J, Lettich EREEGT, Berger M. Cortical language localization in left, dominant hemisphere: an electrical stimulation mapping investigation in 117 patients. J Neurosurg. 1989;71(3):316–26.
Olsen KS. The asleep-awake technique using propofol-remifentanil anaesthesia for awake craniotomy for cerebral tumours. Eur J Anaesthesiol. 2008;25:662–9.
Penfield W, Boldrey E. Somatic motor and sensory representation in the cerebral cortex of man as studied by electrical stimulation. Brain. 1937;60(4):389–443.
Piccioni F, Fanzio M. Management of anesthesia in awake craniotomy. Minerva Anestesiol. 2008;74:393–408.
Picht T, Kombos T, Gramm HJ, et al. Multimodal protocol for awake craniotomy in language cortex tumour surgery. Acta Neurochir. 2006;148:127–37.
Sarang A, Dinsmore J. Anaesthesia for awake craniotomy – evolution of a technique that facilitates awake neurological testing. Br J Anaesth. 2003;90:161–5.
Skirboll SS, Ojemann GA, Berger MS, Lettich E, Winn HR. Functional cortex and subcortical white matter located within gliomas. Neurosurgery. 1996;38(4):678–84; discussion: 684–5.
Szelényi A, Bello L, Duffau H, Fava E, Feigl GC, Galanda M, Neuloh G, Signorelli F, Sala F. Intraoperative electrical stimulation in awake craniotomy: methodological aspects of current practice. Neurosurg Focus. 2010;28(2):E7.
Taylor MD, 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;90:35–41.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Ribas, E.C., Protasio, C.P., Kim, S.K., Keeble, H., Brogna, C. (2021). General Principles of Awake Neurosurgery. In: Figueiredo, E.G., Welling, L.C., Rabelo, N.N. (eds) Neurocritical Care for Neurosurgeons. Springer, Cham. https://doi.org/10.1007/978-3-030-66572-2_34
Download citation
DOI: https://doi.org/10.1007/978-3-030-66572-2_34
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-66571-5
Online ISBN: 978-3-030-66572-2
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)