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CC BY 4.0 · J Neuroanaesth Crit Care 2023; 10(03): 149-154
DOI: 10.1055/s-0043-1777443
Review Article

Intraoperative Stimulation Mapping in Neurosurgery for Anesthesiologists, Part 2: The Anesthetic Considerations

Naeema S. Masohood
1   Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
,
Gabriel Paquin-Lanthier
1   Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
,
Jason Chui
2   Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
,
Nancy Lu
3   Division of Perioperative Surgical Services, Department of Neurosurgical Intraoperative Monitoring, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
,
Tumul Chowdhury
1   Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
,
Lashmi Venkatraghavan
1   Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
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Abstract

Intraoperative language and sensorimotor function mapping with direct electrical stimulation allows precise identification of functionally important brain regions. Direct electrical stimulation brain mapping has become the standard of care for the resection of brain lesions near or within eloquent regions with various patient outcome benefits. Intraoperative stimulation mapping (ISM) is commonly performed in an awake patient for language and motor assessments. However, motor mapping under general anesthesia, termed asleep motor mapping, has been increasingly performed over the last two decades for lesions primarily affecting the motor areas of the brain. Both asleep-awake-asleep and monitored anesthesia care have been successfully used for awake craniotomy in modern neuroanesthesia. Each anesthetic agent exerts varying effects on the quality of ISM, especially under general anesthesia. Careful selection of an anesthetic technique is crucial for the successful performance of ISM in both awake and asleep conditions. A comprehensive search was performed on electronic databases such as PubMed, Embase, Cochrane, Scopus, Web of Science, and Google Scholar to identify articles describing anesthesia for awake craniotomy, intraoperative brain mapping, and asleep motor mapping. In the second part of this narrative review, we summarize the effects of different anesthetic regimes and agents on ISM, causes of the failure of awake craniotomy and mapping, and outline the anesthetic considerations for ISM during awake craniotomy and asleep motor mapping.

Keywords

direct electrical stimulation - intraoperative stimulation mapping - awake craniotomy - asleep motor mapping - monitored anesthesia care - neuroanesthesia


Publication History

Article published online:
04 March 2024

© 2024. 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/)

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