The usefulness of the asleep-awake-asleep glioma surgery

摘要

I enjoyed reading the letter by Doenitz et al. "The usefulness of the awake-awake-awake technique"[3] related to my recent editorial "The reliability of asleep-awake-asleep protocol for intraoperative functional mapping and cognitive monitoring in glioma surgery" [4]. However, in their letter, the authors state that their rates of intraoperative seizures (16 %) and neurological deficits (16 %) are comparable to those reported in the literature. This is not in agreement with my own experience using asleep-awake-asleep surgery, also reported in the literature, with less than 1 % of seizures and less than 2 % of permanent deficits [2, 6]. Secondly, by using asleep-awake-asleep craniotomy in about 500 glioma patients, the rate of aborted procedures (especially due to fear or anxiety) was nil in personal experience. In addition, the authors claim that higher cognitive functions are compromised for at least an hour in patients with intermittent anesthesia or sedation with propofol. This is untrue. In a prospective series with 140 asleep-awake-asleep procedures using propofol, Montpellier's team demonstrated that the patients regained consciousness in a mean time of 14±6 minutes and were fully cooperative after a mean of 20±9 minutes after discontinuation of the IV infusion [2]. Moreover, we were also able to achieve intraoperative mapping of complex functions such as bimanual coordination [12], spatial awareness [13], multimodal semantic processing [10], judgment [11], and even mentalizing [9].