Awake craniotomy in brain tumors - Technique systematization and the state of the art

ABSTRACT The anesthesia for awake craniotomy (AC) is a consecrated anesthetic technique that has been perfected over the years. Initially used to map epileptic foci, it later became the standard technique for the removal of glial neoplasms in eloquent brain areas. We present an AC anesthesia technique consisting of three primordial times, called awake-asleep-awake, and their respective particularities, as well as delve into the anesthetic medications used. Its use in patients with low and high-grade gliomas was favorable for the resection of tumors within the functional boundaries of patients, with shorter hospital stay and lower direct costs. The present study aims to systematize the technique based on the experience of the largest philanthropic hospital in Latin America and discusses the most relevant aspects that have consolidated this technique as the most appropriate in the surgery of gliomas in eloquent areas.

摘要 清醒开颅术（awake craniotomy, AC）是一项历经多年优化完善、已得到广泛认可的麻醉技术。其最初被用于定位癫痫灶，后续逐渐成为脑功能区神经胶质瘤切除的标准术式。本文介绍一种分为三个核心阶段的AC麻醉方案，即清醒-睡眠-清醒模式，并阐述各阶段的独特操作要点，同时深入探讨所使用的麻醉药物。该技术应用于低级别与高级别胶质瘤患者时，可在患者脑功能边界内实现肿瘤全切，且能缩短住院时长、降低直接医疗成本。本研究依托拉丁美洲规模最大的慈善医院的临床经验，对该麻醉技术进行系统化梳理，并讨论了使其成为脑功能区胶质瘤手术最优方案的关键核心要素。