Assessment of wakefulness during awake craniotomy to predict intraoperative language performance

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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.
Article Information

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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References
  • 1

    Avidan MSZhang LBurnside BAFinkel KJSearleman ACSelvidge JA: Anesthesia awareness and the bispectral index. N Engl J Med 358:109711082008

  • 2

    Bekker AYKaufman BSamir HDoyle W: The use of dexmedetomidine infusion for awake craniotomy. Anesth Analg 92:125112532001

  • 3

    Brown TShah AHBregy AShah NHThambuswamy MBarbarite E: Awake craniotomy for brain tumor resection: the rule rather than the exception? J Neurosurg Anesthesiol 25:2402472013

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4

    Burnand CSebastian J: Anaesthesia for awake craniotomy. Contin Educ Anaesth Crit Care Pain 14:6112014

  • 5

    Chang EFSmith JSChang SMLamborn KRPrados MDButowski N: Preoperative prognostic classification system for hemispheric low-grade gliomas in adults. J Neurosurg 109:8178242008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Chang WHPei YCWei KCChao YPChen MHYeh HA: Intraoperative linguistic performance during awake brain surgery predicts postoperative linguistic deficits. J Neurooncol 139:2152232018

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Conte VL’Acqua CRotelli SStocchetti N: Bispectral index during asleep-awake craniotomies. J Neurosurg Anesthesiol 25:2792842013

  • 8

    De Witt Hamer PCRobles SGZwinderman AHDuffau HBerger MS: Impact of intraoperative stimulation brain mapping on glioma surgery outcome: a meta-analysis. J Clin Oncol 30:255925652012

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    Ferrand L: Why naming takes longer than reading? The special case of Arabic numbers. Acta Psychol (Amst) 100:2532661999

  • 10

    Ghazanwy MChakrabarti RTewari ASinha A: Awake craniotomy: a qualitative review and future challenges. Saudi J Anaesth 8:5295392014

  • 11

    Groshev APadalia DPatel SGarcia-Getting RSahebjam SForsyth PA: Clinical outcomes from maximum-safe resection of primary and metastatic brain tumors using awake craniotomy. Clin Neurol Neurosurg 157:25302017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Hansen ESeemann MZech NDoenitz CLuerding RBrawanski A: Awake craniotomies without any sedation: the awake-awake-awake technique. Acta Neurochir (Wien) 155:141714242013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Hervey-Jumper SLBerger MS: Maximizing safe resection of low- and high-grade glioma. J Neurooncol 130:2692822016

  • 14

    Hervey-Jumper SLLi JLau DMolinaro AMPerry DWMeng L: Awake craniotomy to maximize glioma resection: methods and technical nuances over a 27-year period. J Neurosurg 123:3253392015

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15

    Li YMSuki DHess KSawaya R: The influence of maximum safe resection of glioblastoma on survival in 1229 patients: can we do better than gross-total resection? J Neurosurg 124:9779882016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Mack PFPerrine KKobylarz ESchwartz THLien CA: Dexmedetomidine and neurocognitive testing in awake craniotomy. J Neurosurg Anesthesiol 16:20252004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Martino JGomez EBilbao JLDueñas JCVázquez-Barquero A: Cost-utility of maximal safe resection of WHO grade II gliomas within eloquent areas. Acta Neurochir (Wien) 155:41502013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Meng LBerger MSGelb AW: The potential benefits of awake craniotomy for brain tumor resection: an anesthesiologist’s perspective. J Neurosurg Anesthesiol 27:3103172015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Sacko OLauwers-Cances VBrauge DSesay MBrenner ARoux FE: Awake craniotomy vs surgery under general anesthesia for resection of supratentorial lesions. Neurosurgery 68:119211992011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Sanou JGoodall GCapuron LBourdalle-Badie CMaurette P: Cognitive sequelae of propofol anaesthesia. Neuroreport 7:113011321996

  • 21

    Shen SLZheng JYZhang JWang WYJin TZhu J: Comparison of dexmedetomidine and propofol for conscious sedation in awake craniotomy: a prospective, double-blind, randomized, and controlled clinical trial. Ann Pharmacother 47:139113992013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Smith JSChang EFLamborn KRChang SMPrados MDCha S: Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. J Clin Oncol 26:133813452008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Stevanovic ARossaint RVeldeman MBilotta FCoburn M: Anaesthesia management for awake craniotomy: systematic review and meta-analysis. PLoS One 11:e01564482016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Valente APinet SAlario FXLaganaro M: “When” does picture naming take longer than word reading? Front Psychol 7:312016

  • 25

    Wilson SMEriksson DKSchneck SMLucanie JM: A quick aphasia battery for efficient, reliable, and multidimensional assessment of language function. PLoS One 13:e01927732018

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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