2024 FSA Podium and Poster Abstracts
P101: ANESTHETIC MANAGEMENT OF AWAKE CRANIOTOMY FOR EXCISION OF SUPRATENTORIAL HAEMORRHAGIC BRAIN TUMOR
Alex Hugues, MD1; Alex Hendon, MD1; Ryan Stalder, BS2; Joshua Stanton, MD1; Imani Thornton, MD1; 1HCA Westside Regional Medical Center; 2Florida Atlantic University Medical College
Introduction/Background: Awake craniotomy is a surgical procedure that utilizes a unique anesthetic approach in which the patient is deliberately kept awake for part of the procedure. Awake craniotomy is most commonly used to map and resect a brain tumor in critical areas like the motor or language cortex where imaging is not sufficient. The goal of awake craniotomy is to resect as much of the mass as possible without excising functional brain tissue. During testing, an awake patient will let the surgeon know if any functional area is being stimulated so that surgeon can avoid resection of this brain tissue.
Methods: The patient is a 31-year-old female who presented to the hospital due to seizure, headache, and speech difficulties for the past year. The patient reported these symptoms occurred suddenly and she did not follow up with her primary care provider due to social constraints. Upon admission to the emergency department imaging confirmed the presence of a Supratentorial Hemorrhagic Brain Tumor. The neurosurgical team was consulted and after careful examination, the decision for an awake craniotomy with a speech pathologist present was made in order to preserve the patient’s speech and quality of life. Preoperatively the patient was seen by the Anesthesia team, where step-by-step instructions of the operation were explained to the patient since they are an integral part of the process. There are 3 parts of this surgery and the decision for an asleep-awake-asleep approach was agreed upon. Intraoperatively, a laryngeal mask airway device was placed and the patient was anesthetically maintained with propofol and remifentanil. The Neurosurgical team then placed Mayfield pins and obtained dural exposure. Before resection of the tumor, the patient was woken up, the laryngeal device was removed, and the propofol and remifentanil infusions were decreased in order for patient to speak with speech pathologist. Once the surgical team confirmed they were not removing any functional tissue, the tumor was resected. After tumor resection, the mask airway device was re-placed and infusions were restarted in order forthe neurosurgical team to close dura and scalp.
Discussion/Conclusion/Results: The practice of anesthesia is a delicate process with a primary goal of maintaining patient comfort. The removal of a tumor could be achieved under general anesthesia with endotracheal intubation, but in order to maximize the patient’s quality of life after the procedure it was imperative for the patient to be an active participant. Tailoring an anesthetic plan which requires adequate sedation, analgesia, and patient speech is a unique anesthetic approach. There are multiple viable strategies for this operation, but given the patient’s lack of surgical history and recent tumor expansion, the decision for the patient to be asleep for pin placement and dural exposure was important for the patient’s comfort. The patient tolerated the procedure and the tumor was resected with speech function intact.