Assessment of wakefulness during awake craniotomy to predict intraoperative language performance

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  • 1 Department of Neurological Surgery, University of California, San Francisco, California;
  • 2 Departments of Psychology and
  • 3 Neurological Surgery, University of Michigan, Ann Arbor, Michigan; and
  • 4 Department of Anesthesiology, University of California, San Francisco, California
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OBJECTIVE

Maximal safe tumor resection in language areas of the brain relies on a patient’s ability to perform intraoperative language tasks. Assessing the performance of these tasks during awake craniotomies allows the neurosurgeon to identify and preserve brain regions that are critical for language processing. However, receiving sedation and analgesia just prior to experiencing an awake craniotomy may reduce a patient’s wakefulness, leading to transient language and/or cognitive impairments that do not completely subside before language testing begins. At present, the degree to which wakefulness influences intraoperative language task performance is unclear. Therefore, the authors sought to determine whether any of 5 brief measures of wakefulness predicts such performance during awake craniotomies for glioma resection.

METHODS

The authors recruited 21 patients with dominant hemisphere low- and high-grade gliomas. Each patient performed baseline wakefulness measures in addition to picture-naming and text-reading language tasks 24 hours before undergoing an awake craniotomy. The patients performed these same tasks again in the operating room following the cessation of anesthesia medications. The authors then conducted statistical analyses to investigate potential relationships between wakefulness measures and language task performance.

RESULTS

Relative to baseline, performance on 3 of the 4 objective wakefulness measures (rapid counting, button pressing, and vigilance) declined in the operating room. Moreover, these declines appeared in the complete absence of self-reported changes in arousal. Performance on language tasks similarly declined in the intraoperative setting, with patients experiencing greater declines in picture naming than in text reading. Finally, performance declines on rapid counting and vigilance wakefulness tasks predicted performance declines on the picture-naming task.

CONCLUSIONS

Current subjective methods for assessing wakefulness during awake craniotomies may be insufficient. The administration of objective measures of wakefulness just prior to language task administration may help to ensure that patients are ready for testing. It may also allow neurosurgeons to identify patients who are at risk for poor intraoperative performance.

ABBREVIATIONS DES = direct electrical stimulation; QAB = Quick Aphasia Battery.

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Contributor Notes

Correspondence Shawn L. Hervey-Jumper: University of California, San Francisco, CA. shawn.hervey-jumper@ucsf.edu.

INCLUDE WHEN CITING Published online May 31, 2019; DOI: 10.3171/2019.2.JNS183486.

D.B. and S.L.H.J. share senior authorship of this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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