, Volume 155, Issue 10, pp 1803-1804
Date: 14 Jul 2013

The reliability of asleep-awake-asleep protocol for intraoperative functional mapping and cognitive monitoring in glioma surgery

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In this issue of Acta Neurochirurgica, Hansen et al. [9] proposed a new anaesthesiologic protocol for intrasurgical mapping “Awake craniotomies without any sedation: the awake-awake-awake technique”. They reported a series of 50 patients who underwent such “awake-awake-awake” craniotomy for resection of 49 tumors (46 gliomas, three metastasis) and one cavernoma in eloquent areas. Patients did not require any sedation and no or only low-dose opioid treatment. The authors have therefore to be congratulated for their results.

Indeed, beyond the methodological aspect, the main message is that intraoperative electrical mapping should be universally implemented as standard of care for glioma surgery. This was demonstrated in a meta-analysis with 8091 adult patients who underwent resective surgery for supratentorial infiltrative glioma. It was shown that glioma resections using intrasurgical stimulation mapping were associated with fewer late severe neurologic deficits (less than 3.5 %) and mo