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

  • Review Article - Tumor - Glioma
  • Published:
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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.

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Acknowledgments

Collaborators of the ELGGN. Fabien Rech, Michel Wager, Christian F. Freyschlag, Fabio Barone, Denys Fontaine, Johan Pallud, Catarina Viegas, Maria Zetterling, Giannantonio Spena, Geert-Jan Rutten, Nicolas Foroglu, Miran Skrap, Juan Martino, Gord von Campe, Philip deWitt Hamer, Santiago Gil Robles, Silvio Sarubbo, Thomas Santorius, Lorenzo Bello, Marie-Therese Forster, and Hugues Duffau.

Author information

Author notes

  1. Jeremy Arzoine and Charlotte Levé contributed equally to this work.

Authors and Affiliations

  1. Department of Anesthesiology and Critical Care, St-Louis-Lariboisière-Fernand Widal University Hospitals, APHP, Paris, France

    Jeremy Arzoine, Charlotte Levé, Sylvie Aubrun, Etienne Gayat, Fabrice Vallée & Catherine Madadaki

  2. INSERM UMR-942, Paris, France

    Charlotte Levé & Fabrice Vallée

  3. Department of Anesthesiology, Hospital Garcia de Orta, Almada, Portugal

    Antonio Pérez-Hick

  4. Department of Neurosurgery, Leeds General Infirmary, Leeds, UK

    John Goodden

  5. Department of Neurosurgery, Hôpital Pasteur II, University Hospital of Nice, Nice, France

    Fabien Almairac

  6. University Paris 7, Paris, France

    Etienne Gayat & Emmanuel Mandonnet

  7. Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria

    Christian F. Freyschlag

  8. Department of Neurosurgery, Lariboisière Hospital, APHP, Paris, France

    Emmanuel Mandonnet

  9. Frontlab, Institut du Cerveau et de la Moelle épinière, Inserm U 1127, CNRS UMR 7225, Paris, France

    Emmanuel Mandonnet

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  1. Jeremy Arzoine
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Consortia

collaborators of the ELGGN

  • Fabien Rech
  • , Michel Wager
  • , Christian F. Freyschlag
  • , Fabio Barone
  • , Denys Fontaine
  • , Johan Pallud
  • , Catarina Viegas
  • , Maria Zetterling
  • , Giannantonio Spena
  • , Geert-Jan Rutten
  • , Nicolas Foroglu
  • , Miran Skrap
  • , Juan Martino
  • , Gord von Campe
  • , Philip deWitt Hamer
  • , Santiago Gil Robles
  • , Silvio Sarubbo
  • , Thomas Santorius
  • , Lorenzo Bello
  • , Marie-Therese Forster
  •  & Hugues Duffau

Corresponding author

Correspondence to Emmanuel Mandonnet.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Arzoine, J., Levé, C., Pérez-Hick, A. et al. Anesthesia management for low-grade glioma awake surgery: a European Low-Grade Glioma Network survey. Acta Neurochir 162, 1701–1707 (2020). https://doi.org/10.1007/s00701-020-04274-0

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  • DOI: https://doi.org/10.1007/s00701-020-04274-0

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