Awake craniotomy to maximize XXXX resection: methods and technical nuances over a 27-year period.

@entity1 @entity2656 @entity410 @entity198 @entity1313 @entity5 @entity39 @entity2695 @entity146 @entity262 @entity11 @entity6795 @entity1875 @entity159 @entity1937
UNASSIGNED: OBJECT Awake craniotomy is currently a useful surgical approach to help identify and preserve functional areas during cortical and subcortical @entity5 resections. Methodologies have evolved over time to maximize @entity1 safety and minimize morbidity using this technique. The goal of this study is to analyze a single surgeon's experience and the evolving methodology of awake language and sensorimotor mapping for @entity11 surgery. METHODS The authors retrospectively studied @entity1 undergoing awake @entity1313 surgery between 1986 and 2014. Operations for the initial 248 @entity1 (1986-1997) were completed at the University of Washington, and the subsequent surgeries in 611 @entity1 (1997-2014) were completed at the University of California, San Francisco. Perioperative risk factors and complications were assessed using the latter 611 cases. RESULTS The median @entity1 age was 42 years (range 13-84 years). Sixty percent of @entity1 had @entity159 ( @entity159 ) scores of 90-100, and 40% had @entity159 scores less than 80. Fifty-five percent of @entity1 underwent surgery for high-grade @entity11 , 42% for low-grade @entity11 , 1% for metastatic lesions, and 2% for other lesions ( @entity6795 , @entity198 , @entity39 , abscess, and @entity2695 ). The majority of @entity1 were in American Society of Anesthesiologists (ASA) Class 1 or 2 (mild @entity262 ); however, @entity1 with severe @entity262 were not excluded from awake @entity1313 surgery and represented 15% of study @entity1 . Laryngeal mask airway was used in 8 @entity1 (1%) and was most commonly used for large @entity5 with more than 2 cm of mass effect. The most common sedation regimen was @entity1875 plus @entity1937 (54%); however, 42% of @entity1 required an adjustment to the initial sedation regimen before skin incision due to @entity1 intolerance. @entity2656 was used in 54% of cases. Twelve percent of @entity1 were active smokers at the time of surgery, which did not impact completion of the intraoperative mapping procedure. Stimulation-induced @entity410 occurred in 3% of @entity1 and were rapidly terminated with ice-cold Ringer's solution. Preoperative @entity410 history and @entity5 location were associated with an increased incidence of stimulation-induced @entity410 . Mapping was aborted in 3 cases (0.5%) due to intraoperative @entity410 (2 cases) and @entity1 emotional intolerance (1 case). The overall perioperative complication rate was 10%. CONCLUSIONS Based on the current best practice described here and developed from multiple regimens used over a 27-year period, it is concluded that awake @entity1313 surgery can be safely performed with extremely low complication and failure rates regardless of ASA classification; body mass index; smoking status; @entity146 or emotional history; @entity410 frequency and duration; and @entity5 site, size, and pathology.
