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Acta Neurochirurgica
Published in: Acta Neurochirurgica 7/2020

01-07-2020 | Glioma | Review Article - Tumor - Glioma

Anesthesia management for low-grade glioma awake surgery: a European Low-Grade Glioma Network survey

Authors: Jeremy Arzoine, Charlotte Levé, Antonio Pérez-Hick, John Goodden, Fabien Almairac, Sylvie Aubrun, Etienne Gayat, Christian F. Freyschlag, Fabrice Vallée, Emmanuel Mandonnet, Catherine Madadaki, collaborators of the ELGGN

Published in: Acta Neurochirurgica | Issue 7/2020

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Abstract

Background

Awake surgery has become a key treatment of diffuse low-grade gliomas (DLGG) and is divided in three main phases: opening, tumor resection – during which the patient needs to be fully awake – and closure. The anesthetic management of awake neurosurgery is a challenge, and there are currently no guidelines.

Objective

The objective of the survey was to explore differences and commonalities regarding the anesthetic management of awake DLGG surgery within the European Low-Grade Glioma Network (ELGGN) centers.

Methods

A form that contained 14 questions about the anesthetic management was sent to 28 centers in May 2015.

Results

Twenty centers responded. During the opening and closing non-awake periods, 56% of teams chose general anesthesia with mechanical ventilation for at least one period (asleep-awake-asleep, SAS protocol), and 44% monitored anesthesia care including sedation without mechanical ventilation (MAC protocol). In case of SAS, all the teams chose intravenous anesthesia, 82% used laryngeal mask instead of endotracheal intubation during the opening sequence, and 71% during closure. Local and regional anesthesia was practiced by all the teams. The most frequently reported cause of pain was dural and cerebral vessels manipulation (77%). Pain management was mostly based on paracetamol (70%) and remifentanil (55%).

Conclusion

Our survey showed that there was an equivalent proportion of centers using SAS or MAC protocols in the anesthetic management of awake surgery in ELGGN centers. The advantages and disadvantages of each anesthesia protocol were reviewed.
Appendix
Available only for authorised users
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Metadata
Title
Anesthesia management for low-grade glioma awake surgery: a European Low-Grade Glioma Network survey
Authors
Jeremy Arzoine
Charlotte Levé
Antonio Pérez-Hick
John Goodden
Fabien Almairac
Sylvie Aubrun
Etienne Gayat
Christian F. Freyschlag
Fabrice Vallée
Emmanuel Mandonnet
Catherine Madadaki
collaborators of the ELGGN
Publication date
01-07-2020
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 7/2020
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-020-04274-0

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