Báo cáo ca lâm sàng gây mê trong phẫu thuật não tỉnh

Awake craniotomy represents a sophisticated neurosurgical technique vital for treating various brain pathologies, particularly those in eloquent areas. This approach, which allows for intraoperative neurological function monitoring, is crucial for maximizing lesion resection while meticulously preserving critical neurological functions like motor and speech. Despite its clear advantages in enhancing patient outcomes and reducing complications associated with general anesthesia, successful implementation hinges on a complex interplay of patient cooperation, multidisciplinary team collaboration, and precise anesthetic management. However, a standardized consensus on the optimal anesthetic approach for awake craniotomy remains elusive, posing significant challenges for anesthesiologists. This report highlights the importance of tailored anesthetic strategies and the evolving role of awake craniotomy in modern neurosurgical practice.

Neurosurgeons, anesthesiologists, neurologists, neurophysiologists, and critical care physicians involved in brain surgery.

Awake craniotomy is a neurosurgical procedure where the patient is awake during parts of the operation, enabling intraoperative electrophysiological monitoring and brain mapping. This technique allows surgeons to identify and preserve crucial neurological functions while maximally removing pathological brain tissue, such as tumors or epileptogenic foci. Its historical roots trace back to 1886, with significant advancements driven by modern neuroimaging, intraoperative monitoring (IONM), and refined anesthetic techniques. The success of awake craniotomy critically depends on meticulous patient selection, comprehensive pre-operative preparation, and seamless communication and consensus among a multidisciplinary team, including neurosurgeons, anesthesiologists, and operating room staff. While its benefits include enhanced functional preservation, reduced neurological deficits, and potentially shorter hospital stays or ICU admissions compared to general anesthesia, there is currently no universal consensus on the optimal anesthetic protocol. The choice of anesthesia, such as Asleep-Awake-Asleep or Awake-Asleep methods, is individualized based on patient characteristics, the type of surgery (e.g., epilepsy lesion removal, deep brain stimulation electrode placement), and the surgical team's experience. Key anesthetic considerations include airway management, hemodynamic stability, and intracranial pressure control. Scalp block plays a pivotal role in pain management during the procedure. This report presents two clinical cases from Vinmec Central Park, illustrating the application of different anesthetic approaches for epilepsy surgery and deep brain stimulation. It underscores that despite potential complications like seizures, hypertension, or nausea, careful management and a tailored approach can lead to successful outcomes. The document advocates for further development of standardized guidelines to facilitate the wider and safer adoption of awake craniotomy, especially in regions where its practice is still emerging.