Simplifying the Technique of Awake Brain Surgery in a Condition of Less Equipped Neurosurgical Institution in Uzbekistan

Dilshod Mukhammadvalievich Mamadaliev; Gayrat Maratovich Kariev; Ulugbek Maksudovich Asadullaev; Jakhongir Bakhodirovich Yakubov; Kamoliddin Sodikjonovich Zokirov; Khabibullo Abdukholikovich Khasanov; Tokhir Makhmudovich Akhmediev; Dmitriy Sergeyevich Korotkov

doi:10.1055/s-0043-1771326

Asian Journal of Neurosurgery, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(03): 636-645
DOI: 10.1055/s-0043-1771326

Case Report

Simplifying the Technique of Awake Brain Surgery in a Condition of Less Equipped Neurosurgical Institution in Uzbekistan

Authors

Dilshod Mukhammadvalievich Mamadaliev

¹Department of Skull Base Surgery, Republican Specialized Scientific-Practical Medical Center of Neurosurgery, Tashkent, Uzbekistan
Gayrat Maratovich Kariev

¹Department of Skull Base Surgery, Republican Specialized Scientific-Practical Medical Center of Neurosurgery, Tashkent, Uzbekistan

²Department of Nervous Diseases and Neurosurgery, Peoples Friendship University of Russia, Moscow, Russia
Ulugbek Maksudovich Asadullaev

¹Department of Skull Base Surgery, Republican Specialized Scientific-Practical Medical Center of Neurosurgery, Tashkent, Uzbekistan
Jakhongir Bakhodirovich Yakubov

¹Department of Skull Base Surgery, Republican Specialized Scientific-Practical Medical Center of Neurosurgery, Tashkent, Uzbekistan
Kamoliddin Sodikjonovich Zokirov

³Department of Anesthesiology and ICU, Republican Specialized Scientific Practical Medical Center of Neurosurgery, Tashkent, Uzbekistan
Khabibullo Abdukholikovich Khasanov

⁴Department of Traumatology, Orthopedics, Military-Field Surgery, and Neurosurgery, Tashkent Medical Academy, Tashkent, Uzbekistan
Tokhir Makhmudovich Akhmediev

⁴Department of Traumatology, Orthopedics, Military-Field Surgery, and Neurosurgery, Tashkent Medical Academy, Tashkent, Uzbekistan
Dmitriy Sergeyevich Korotkov

⁵Department of Neurosurgery, National Children Medical Center, Tashkent, Uzbekistan

⁶Federal University of Sao Paulo, Sao Paulo, Brazil

Abstract

Currently, awake craniotomy (AC) is one of the most often employed procedures to map and resect tumors in eloquent brain areas, avoiding the use of general anesthesia (GA) and thereby reducing anesthesia-related complications and cost of surgery. Resource limitations are one of the basic reasons for avoiding AC in low- and middle-income countries (LMICs). The aim of this study is to describe the simplified protocol of awake brain surgery that can be implemented in a limited financial setting in LMICs and to share our first experience. Twenty-five patients diagnosed with tumor of the left frontotemporal lobes, all involving Broca's and Wernicke's areas, were operated on using AC. Brain mapping was executed using mono- and bipolar direct electrical stimulation including cortical and subcortical (axonal) mapping profiles, investigating basically cortical language centers. Neither neuronavigation nor intraoperative magnetic resonance imaging (MRI) was utilized due to financial constraints. AC was performed successfully in 23 of 25 patients, achieving a near-total resection in 16 (69.5%) patients, subtotal resection in 4 patients (17.39%) patients, and partial resection in 3 (13.04%) patients. In two patients, due to psychological instability—agitation and fear during the awake phase—speech test was not technically possible, so they were reintubated by giving them GA. There was no mortality in the early or postoperative period. In spite of the absence of advanced pre- and intraoperative technologies such as intraoperative MRI and navigation systems, AC can be safely performed in LMICs. These tools along with intraoperative cortical mapping and language testing can guarantee better surgical outcomes and quality of life. However, our study confirms that omitting these tools does not make a huge difference in getting good results with AC and that AC is not absolutely impossible. AC can be performed successfully, preserving eloquent brain areas, with minimum and basic set of the armamentarium like system for cortical and subcortical intraoperative neurostimulation which provides cortical/subcortical brain mapping.

Keywords

awake craniotomy - cortical mapping - electrophysiological monitoring - language testing - brain tumor

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Referenzen

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