Brosnan Heather, McLean Maranatha, Abramowicz Apolonia E
Anesthesiology, Westchester Medical Center/New York Medical College, Valhalla, USA.
Anesthesiology, University of Texas Southwestern Medical Center, Dallas, USA.
Cureus. 2022 Mar 15;14(3):e23181. doi: 10.7759/cureus.23181. eCollection 2022 Mar.
Awake craniotomies for tumor resections allow for the preservation of eloquent cortex; however, they are high-risk surgeries that require careful patient selection and meticulous anesthetic management. Patients with significant preoperative language deficits may be unable to participate in intraoperative language mapping, increasing the risk of a failed surgery. Furthermore, anesthetic agents given for sedation and analgesia during the initial portion of the surgery may exacerbate existing language deficits. We present a case of an asleep-awake-asleep craniotomy for a left temporal lobe glioma using intraoperative neuronavigation, 5-aminolevulinic acid fluorescence, and awake speech mapping for a patient with a significant preoperative language deficit, for whom sedation had to be meticulously titrated to optimize intraoperative language testing. Anesthetic titration was aided by bispectral index monitoring, ultimately allowing successful awake speech mapping and tumor resection.
清醒开颅肿瘤切除术可保留明确的皮质；然而，它们是高风险手术，需要仔细选择患者并进行细致的麻醉管理。术前存在明显语言缺陷的患者可能无法参与术中语言图谱绘制，增加手术失败的风险。此外，手术初期给予镇静和镇痛的麻醉药物可能会加重现有的语言缺陷。我们报告一例左颞叶胶质瘤患者采用术中神经导航、5-氨基酮戊酸荧光和清醒言语图谱绘制进行清醒-睡眠-清醒开颅手术的病例，该患者术前存在明显语言缺陷，必须对镇静进行细致滴定以优化术中语言测试。双谱指数监测辅助麻醉滴定，最终成功进行清醒言语图谱绘制和肿瘤切除。
