Awake Brain Tumor Surgery Protocol

The study protocol and informed consent documents were approved by the Ethics Committee of Verona University Hospital. All patients provided their informed consent prior to entering the study. The study population was seven patients (4 males and 3 females; mean age, 54±19.9 years; range, 36–85) undergoing brain tumor surgery for: glioma (n = 4); meningioma (n = 1); and cavernous angioma (n = 2) (Table 1). Since patient guidance is essential and each step of the stimulation procedure is announced, the patients were awake after craniotomy. Anesthesia was induced with bolus doses of propofol 0.8 mg Kg⁻¹h⁻¹, remifentanil 0.01 gamma Kg⁻¹ min⁻¹ totally endovenous and 5 mg midazolam (benzodizepine) as co-adjuvant. The craniotomy was performed while the patient was under local anesthesia. During cortical mapping the propopofol was suspended and the remifentanil was maintained at 0.01 gamma Kg⁻¹min⁻¹. As the patients were carefully examined and asked about sensation, feelings, or movements, they had to be awake and cooperative with a full level of consciousness. After tumor surgery, propofol was increased from 0.8 mg Kg⁻¹h⁻¹to 1.5 mg Kg⁻¹h⁻¹and remifentanil from 0.01 gamma Kg⁻¹ min⁻¹to 0.04 gamma Kg⁻¹ min⁻¹.