Awake craniotomy

Case-1

Tumors located adjacent to the eloquent cortex / regions have a high chance of neurological deficit if operated conventionally under anaesthesia. Awake craniotomy in these patients allows for safe excision of the tumor with minimal morbidity.

In the first column, the patient had tumor in posterior frontal lobe with involvement of motor cortex. She underwent awake craniotomy and safe removal of the tumor without any deficits by continuously monitoring the movements of the contralateral limbs. The posterior limit could be reached safely upto the motor cortex (as seen in post-op image)

In the second column, the patient had a tumor in left posterior temporal lobe, in close proximity to the speech area. He too underwent awake craniotomy with continuous monitoring of speech while removing the tumor. Post-op scan shows adequate removal of the tumor with no deficits in speech.

Aids used: Neuro-navigation, microscope, CUSA.

Pre-op MRI with tumors abutting and involving the motor cortex

Post-op MRI shows tumor excised upto the motor cortex with intact motor cortex.

Left temporal heterogenously enhancing mass lesion

Post-op CT with adequate removal of the tumor

Case-2

Eloquent cortex glioma excised by Awake craniotomy with Intra-operative Neurophysiological monitoring.

We present case of recurrent left posterior frontal glioma who successfully underwent tumor excision using this combined modality. Towards the end, there were transient deficits and positive EMG responses following which, further decompression was stopped. Post-op, patient recovered well with transient right hemiparesis which recovered over 2-3 days.

By using these modalities, functional nerves in the tumor could be identified and further tumor removal stopped. “Maximal safe resection could thus be achieved with intact function”

Case-3

Awake craniotomy for a Left Insular Cortex Glioma

Left insular cortex glioma are challenge to operate upon due to proximity to speech and motor areas. We present one such case operated by Awake Craniotomy.

In this procedure, patient is conscious and his speech and movements of right sided limbs are being monitored continuously while the tumor is removed. Patient is asked to count, name objects from pictures and move his right hand and legs during the surgery.

As seen from scans, significant tumor could be removed. Small residual along posterior insular could not be removed due to onset of weakness of lower limb movement. Further dissection was stopped to avoid neurological deficit. Thus maximal tumor resection could be achieved safely while preserving neurological function.

Case-4

“ब्रेन ट्यूमर की सुरक्षित और सफल सर्जरी”
16 साल की पेशंट के ब्रेन ट्यूमर को बिना बेहोशी के मस्तिस्क को सुन्न कर (awake craniotomy) सफल ऑपरेशन किया गया। यह केस हमारे डिपार्टमेंट की एक और सफलता है । इसमें पेशंट का ट्यूमर motor cortex (ब्रेन का वो सेंटर जहां से हाथ और पैर से कंट्रोल होता गई) के बहुत नज़दीक था। ऑपरेशन के दौरान इसे हानि ना पहुँचे इसलिए इस ऑपरेशन में 3 स्पेशल तकनीक का उपयोग किया गया — 1. Awake craniotomy — इसमें पेशंट होश में होता है और ऑपरेशन के दौरान continuous testing की जाती है। इसलिए, इसमें नसों में दुष्परिणाम होने की सम्भावना कम हो जाती है। 2. Intra-operative neuromonitoring — इसमें critical area जैसे कि motor cortex की mapping सर्जरी के शुरुआत में होती है और उस area को ऑपरेशन के दौरान सुरक्षित रखा जा सकता है। 3. Neuronavigation — इसमें सर्जरी से पहले ही ट्यूमर की planning हो जाती है और precision (सटीक) surgery की जा सकती है।