Download PDF
CC BY 4.0 · J Neuroanaesth Crit Care
DOI: 10.1055/s-0042-1760269
Case Report

Awake Aneurysm Clipping: Challenges Conquered

Kirandeep Kaur
1   Division of Neuroanaesthesia, Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education & Research, Chandigarh, India
,
Priya Thappa
1   Division of Neuroanaesthesia, Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education & Research, Chandigarh, India
,
Ankur Luthra 
2   Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education & Research, Chandigarh, India
,
Rajeev Chauhan
2   Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education & Research, Chandigarh, India
,
Nidhi Panda
1   Division of Neuroanaesthesia, Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education & Research, Chandigarh, India
,
Sushanta K. Sahoo
3   Department of Neurosurgery, Post Graduate Institute of Medical Education & Research, Chandigarh, India
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Microsurgical aneurysm clipping under general anesthesia is considered a definitive procedure for the obliteration of unruptured and ruptured aneurysms. Aneurysm clipping can present with postoperative neurological complications, which can be missed under general anesthesia even with intraoperative neurophysiological monitoring. Real-time monitoring with awake patients can help prevent and treat these complications very early. The anesthesiologist has a vital role in awake aneurysm surgery from providing adequate surgical conditions to patient satisfaction and managing intraoperative complications. We report the first-hand experience as a neuroanesthesiology team managing awake craniotomy and aneurysm clipping.

Keywords

awake craniotomy - dexmedetomidine - unruptured and aneurysm clipping


Publication History

Article published online:
24 April 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Park D, Kim BH, Lee SE. et al. Usefulness of intraoperative neurophysiological monitoring during the clipping of unruptured intracranial aneurysm: diagnostic efficacy and detailed protocol. Front Surg 2021; 8: 631053
    CrossrefPubMedGoogle Scholar
  • 2 Passacantilli E, Anichini G, Cannizzaro D. et al. Awake craniotomy for trapping a giant fusiform aneurysm of the middle cerebral artery. Surg Neurol Int 2013; 4: 39
    CrossrefPubMedGoogle Scholar
  • 3 Suzuki K, Mikami T, Sugino T. et al. Discrepancy between voluntary movement and motor-evoked potentials in evaluation of motor function during clipping of anterior circulation aneurysms. World Neurosurg 2014; 82 (06) e739-e745
    CrossrefPubMedGoogle Scholar
  • 4 Lüders JC, Steinmetz MP, Mayberg MR. Awake craniotomy for microsurgical obliteration of mycotic aneurysms: technical report of three cases. Neurosurgery 2005; 56 (1, Suppl): E201
    PubMedGoogle Scholar
  • 5 Yang W, Huang J. Treatment of middle cerebral artery (MCA) aneurysms: a review of the literature. Chin Neurosurg J. 2015; 1 (01) 1-7
    CrossrefPubMedGoogle Scholar
  • 6 Rinne J, Hernesniemi J, Niskanen M, Vapalahti M. Analysis of 561 patients with 690 middle cerebral artery aneurysms: anatomic and clinical features as correlated to management outcome. Neurosurgery 1996; 38 (01) 2-11
    CrossrefPubMedGoogle Scholar
  • 7 Morita A, Kirino T, Hashi K. et al; UCAS Japan Investigators. The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med 2012; 366 (26) 2474-2482
    CrossrefPubMedGoogle Scholar
  • 8 Luthra A, Rath GP. Ketamine: a neuroanesthesiologist's friend or foe?. J Neuroanaesth Crit Care 2018; 5 (02) 77-82
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Rothwell J, Burke D, Hicks R, Stephen J, Woodforth I, Crawford M. Transcranial electrical stimulation of the motor cortex in man: further evidence for the site of activation. J Physiol 1994; 481 (Pt 1): 243-250
    CrossrefPubMedGoogle Scholar
  • 10 Choi HH, Ha EJ, Cho WS, Kang HS, Kim JE. Effectiveness and limitations of intraoperative monitoring with combined motor and somatosensory evoked potentials during surgical clipping of unruptured intracranial aneurysms. World Neurosurg 2017; 108: 738-747
    CrossrefPubMedGoogle Scholar