Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences.
Department of Surgery, Section-Neurosurgery, Clincian Investigator Program, Max Rady College of Medicine, Rady Faculty of Health Sciences.
J Neurosurg Anesthesiol. 2022 Jan 1;34(1):e46-e51. doi: 10.1097/ANA.0000000000000699.
The role of high-field 3-Tesla intraoperative magnetic resonance imaging (I-MRI) during awake craniotomy (AC) has not been extensively studied. We report the feasibility and safety of AC during 3-Tesla I-MRI.
This retrospective descriptive report compared 3 groups: AC with minimal sedation and I-MRI; I-MRI-guided craniotomy under general anesthesia (GA), and; AC without I-MRI. Perioperative factors, surgical, anesthetic and radiologic complications, and postoperative morbidity and mortality were recorded.
Overall, 85 patients are included in this report. Five of 23 patients (22%) who underwent AC with I-MRI had anesthetic complications (nausea/vomiting and conversion to GA) compared with 3 of 40 (8%) who underwent I-MRI-guided craniotomy under GA (nausea/vomiting during extubation, and arrhythmia). Intraoperative surgical complications (seizures and speech deficits) occurred in 5 patients (22%) who underwent AC and I-MRI, excessive intraoperative bleeding occurred in 2 patients (5%) who had I-MRI-guided craniotomy under GA, and 4 of 22 (18%) patients who underwent AC without I-MRI experienced neurological complications (seizures, motor deficits, and transient loss of consciousness). Eight patients (20%) who had I-MRI with GA had postoperative complications, largely neurological. The duration of surgery and anesthesia were shortest in the group of patients receiving AC without I-MRI. Seventy-three percent of the patients in this group had residual tumor postoperatively compared with 44% and 38% in those having I-MRI with AC or GA, respectively. Patients who underwent I-MRI-guided craniotomy with GA had the highest morbidity (8%) at hospital discharge.
Our institutional experience suggests that AC under 3-Tesla I-MRI could be an option for glioma resection, although firm conclusions cannot be drawn given the limited and heterogenous nature of our data. Future multicenter trials comparing anesthetic and imaging modalities for glioma resection are recommended.
高磁场 3 特斯拉术中磁共振成像（I-MRI）在清醒开颅术中的作用尚未得到广泛研究。我们报告了在 3 特斯拉 I-MRI 下进行清醒开颅术（AC）的可行性和安全性。
本回顾性描述性报告比较了 3 组患者：接受最小镇静和 I-MRI 的 AC；全身麻醉（GA）下的 I-MRI 引导开颅术；以及无 I-MRI 的 AC。记录围手术期因素、手术、麻醉和放射学并发症以及术后发病率和死亡率。
总体而言，本报告共纳入 85 例患者。在接受 AC 联合 I-MRI 的 23 例患者中，有 5 例（22%）出现麻醉并发症（恶心/呕吐和转为 GA），而在接受 GA 下 I-MRI 引导开颅术的 40 例患者中，有 3 例（8%）出现（拔管时恶心/呕吐和心律失常）。在接受 AC 和 I-MRI 的 5 例患者（22%）中出现术中手术并发症（癫痫发作和言语障碍），在接受 GA 下 I-MRI 引导开颅术的 2 例患者（5%）中出现术中过度出血，在未接受 I-MRI 的 22 例患者中（18%）有 4 例出现神经并发症（癫痫发作、运动障碍和短暂意识丧失）。8 例（20%）接受 GA 下 I-MRI 的患者出现术后并发症，主要为神经并发症。未接受 I-MRI 的 AC 组患者的手术和麻醉时间最短。该组患者术后有 73%残留肿瘤，而接受 AC 联合 I-MRI 和 GA 下 I-MRI 的患者分别为 44%和 38%。接受 GA 下 I-MRI 引导开颅术的患者在出院时发病率最高（8%）。
我们机构的经验表明，在 3 特斯拉 I-MRI 下进行 AC 可能是胶质瘤切除术的一种选择，尽管鉴于我们数据的有限性和异质性，不能得出确定的结论。建议进行比较胶质瘤切除术的麻醉和成像方式的多中心试验。
