Assessment of wakefulness during awake craniotomy to predict intraoperative language performance
Assessment of wakefulness during awake craniotomy to predict intraoperative language performance
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DOI：
10.3171/2019.2.jns183486
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发表时间：
2020-06-01
影响因子：
4.1
通讯作者：
Hervey-Jumper, Shawn L.
中科院分区：
文献类型：
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作者：
Aabedi, Alexander A.;Ahn, EunSeon;Hervey-Jumper, Shawn L.
目的最大限度地安全切除脑内语言区肿瘤取决于患者执行术中语言任务的能力。在清醒开颅手术中评估这些任务的表现，使神经外科医生能够识别和保留对语言处理至关重要的大脑区域。然而，在经历清醒的开颅手术之前接受镇静和止痛可能会减少患者的清醒程度，导致短暂的语言和/或认知障碍，这些障碍在语言测试开始之前不会完全消退。目前，觉醒对术中语言任务表现的影响程度尚不清楚。因此，作者试图确定在清醒开颅手术切除脑胶质瘤时，5项简单的觉醒测量中是否有任何一项可以预测这种表现。每个患者在接受清醒开颅手术前24小时，除了图片命名和文本阅读语言任务外，还进行了基线觉醒测量。在麻醉药物停止后，患者在手术室再次执行同样的任务。结果相对于基线，在手术室中，4项客观觉醒测量中的3项(快速计数、按下按钮和警觉)的表现有所下降。此外，这些下降是在完全没有自我报告的唤醒变化的情况下出现的。在术中环境下，患者在语言任务上的表现同样下降，患者在图片命名方面的下降比在文本阅读方面的下降更大。最后，在快速计数和警觉觉醒任务上的性能下降预测了图片命名任务的性能下降。结论目前用于评估清醒开颅手术中的觉醒程度的主观方法可能是不够的。在执行语言任务之前进行客观的觉醒测量可能有助于确保患者为测试做好准备。它还可以让神经外科医生识别哪些患者存在术中表现不佳的风险。
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.