NYMC Faculty Publications

Anesthetic Selection for an Awake Craniotomy for a Glioma With Wernicke's Aphasia: A Case Report

Author Type(s)

Faculty

DOI

10.7759/cureus.23181

Journal Title

Cureus

First Page

e23181

Document Type

Article

Publication Date

3-1-2022

Department

Anesthesiology

Abstract

Awake craniotomies for tumor resections allow for the preservation of eloquent cortex; however, they are high-risk surgeries that require careful patient selection and meticulous anesthetic management. Patients with significant preoperative language deficits may be unable to participate in intraoperative language mapping, increasing the risk of a failed surgery. Furthermore, anesthetic agents given for sedation and analgesia during the initial portion of the surgery may exacerbate existing language deficits. We present a case of an asleep-awake-asleep craniotomy for a left temporal lobe glioma using intraoperative neuronavigation, 5-aminolevulinic acid fluorescence, and awake speech mapping for a patient with a significant preoperative language deficit, for whom sedation had to be meticulously titrated to optimize intraoperative language testing. Anesthetic titration was aided by bispectral index monitoring, ultimately allowing successful awake speech mapping and tumor resection.

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