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Awake Surgery: Performing an Awake Craniotomy

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Intraoperative Monitoring

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Abstract

Language and cognitive mapping protocols are technically advancing for better results and less epileptogenic events. The mapping technique was first used by Penfield in 1937 who used a 2.5ms pulse duration. Ojemann established a biphasic 1ms technique as a standard in the 1970s. Recently, high-frequency assembly has been introduced for language mapping. Comprehensive understanding of the issues that impact on neural activation, chronaxie, rheobase, and axon fiber is important to correctly judge the efficacy of low- and high-frequency mapping techniques. This chapter focuses on awake craniotomy from a perspective of technical details to ensure a rigorously correct mapping. Side effects and risks related to direct electrical brain stimulation are discussed.

Additionally, language tasks are presented regarding triggering steps and overall patient evaluation. Preoperative, intraoperative, and postoperative tests are explained and made available for readers’ usage.

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Abbreviations

CC:

Corpus callosum

CNS:

Central nervous system

DES:

Direct electrical stimulation

DTI:

Tractography

ECoG:

Electrocorticography

EOR:

Extent of resection

FLAIR:

Fluid-attenuated inversion recovery

GBM:

Glioblastoma

GTR:

Gross total resection

HF:

High frequency

HFC:

High functional connectivity

IDH:

Dehydrogenase gene

iMRI:

Intraoperative magnetic resonance imaging

IOM:

Intraoperative neurophysiology monitoring

ioUS:

Intraoperative ultrasound

LF:

Low frequency

LLG:

Low-grade glioma

MEG:

Magnetoencephalography

MEP:

Motor evoked potential

MGMT:

O6-methylguanine-DNA methyltransferase

NF:

Neurophysiologist

OMFTCT:

Ohy-Maldaun Fast Track Cognitive Test

ON:

Object naming

VMLA:

Verst-Maldaun Language Assessment

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Authors and Affiliations

  1. Instituto de Ensino e Pesquisa (Research and Educational Institute) of Sírio Libanês Hospital, São Paulo, Brazil

    Silvia Mazzali Verst

  2. Brain Spine Neurofisiologia, Jundiaí, SP, Brazil

    Silvia Mazzali Verst

  3. Researcher at Instituto de Ensino e Pesquisa (Teaching and Research Institute) of Hospital Sirio Libanês, São Paulo, SP, Brazil

    Juliana Ohy & Cleiton Formentin

  4. Instituto de Ensino e Pesquisa (Teaching and Research Institute) of Hospital Sirio Libanês, São Paulo, SP, Brazil

    Marcos Vinicius Calfat Maldaun

  5. Neurosurgery Department, Hospital Sirio Libanês, São Paulo, São Paulo, Brazil

    Marcos Vinicius Calfat Maldaun

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  1. Silvia Mazzali Verst
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  2. Juliana Ohy
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  3. Cleiton Formentin
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  4. Marcos Vinicius Calfat Maldaun
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Editors and Affiliations

  1. Instituto de Ensino e Pesquisa (Research and Teaching Institute), Hospital Sírio Libanês, São Paulo, Brazil

    Silvia Mazzali Verst

  2. Neurophisiology Department, Vitoria Apart Hospital, Serra, Espírito Santo, Brazil

    Maria Rufina Barros

  3. Neurosurgery Department, Hospital Sírio Libanês, São Paulo, São Paulo, Brazil

    Marcos Vinicius Calfat Maldaun

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Verst, S.M., Ohy, J., Formentin, C., Maldaun, M.V.C. (2022). Awake Surgery: Performing an Awake Craniotomy. In: Verst, S.M., Barros, M.R., Maldaun, M.V.C. (eds) Intraoperative Monitoring. Springer, Cham. https://doi.org/10.1007/978-3-030-95730-8_17

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