Acta Neurochirurgica

, Volume 156, Issue 8, pp 1491–1492 | Cite as

The usefulness of the awake-awake-awake technique

  • Christian Doenitz
  • Alexander Brawanski
  • Ernil Hansen
Letter to the editor - Brain Tumors

Dear Sirs,

We appreciate the comments from Dr. Duffau [3] on our paper “Awake craniotomies without any sedation: the awake-awake-awake technique” [5].

We agree that an awake patient is the best candidate for intraoperative neurological testing, and it is obvious that the less the patient is mentally compromised by sedatives, the better the test results will be. Thus, in a recent publication we could demonstrate that patients show unimpaired alertness with our procedure, whereas higher cognitive functions were compromised for at least an hour in other patients with intermittent anesthesia or sedation with propofol [6].

We fully agree that during the purely surgical phases the patient should not follow this in the sense of focusing on the surgical procedure. Duffau here suggests the use of sedation in accordance with the common asleep-awake-asleep technique. As the sedatives and anesthetics in question are also called “hypnotics”, it is justified to ask if only a pharmacological...


Astrocytoma Delay Testing High Cognitive Function Emotional Feeling Neurological Testing 
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Conflicts of interest



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    Beez T, Boge K, Wager M, Whittle I, Fontaine D, Spena G, Braun S, Szelényi A, Bello L, Duffau H, Sabel M, European Low Grade Glioma Network (2013) Tolerance of awake surgery for glioma: a prospective European low grade glioma network multicenter study. Acta Neurochir (Wien) 155(7):1301–1308CrossRefGoogle Scholar
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    Hansen E, Seemann M, Zech N, Doenitz C, Luerding R, Brawanski A (2013) Awake craniotomies without any sedation: the awake-awake-awake technique. Acta Neurochir (Wien) 155:1417–1424CrossRefGoogle Scholar
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    Ott C, Kerscher C, Luerding R, Doenitz C, Hoehne J, Zech N, Seemann M, Schlaier J, Brawanski A (2014) The impact of sedation on brain mapping: a prospective, interdisciplinary clinical trial. Neurosurgery DOI:  10.1227/NEU.0000000000000359
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Copyright information

© Springer-Verlag Wien 2014

Authors and Affiliations

  • Christian Doenitz
    • 1
  • Alexander Brawanski
    • 1
  • Ernil Hansen
    • 2
  1. 1.Department of NeurosurgeryUniversity Hospital RegensburgRegensburgGermany
  2. 2.Department of AnesthesiologyUniversity Hospital RegensburgRegensburgGermany

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