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The first 25 slides, exactly as they appear. The full deck has 63 content slides.
Neurosurgery
Awake Craniotomy
Built from Feldman — Neurosurgical Operative Atlas: Neuro-Oncology
What’s inside
8 sections · 63 slides
Overview
- What this deck will teach you
Why operate on an awake brain?
- What exactly is an awake craniotomy?
- The core problem: “eloquent” brain
- Two goals pulling in opposite directions
- Why extent of resection matters
- Direct electrical stimulation — the gold standard
- Awake surgery is a team sport
Choosing the right patient
- Who is a candidate?
- Which hemisphere controls language?
- Insular tumors — a special challenge
- Who is NOT an ideal candidate
- Working around obesity and the airway
Pre-operative preparation
- The patient is the center of everything
- Baseline neurological and language exam
- The “sleep–awake–sleep” technique
- Functional MRI (fMRI)
- Navigated transcranial magnetic stimulation (nTMS)
- Diffusion tensor imaging and subcortical tracts
- One map from many: the multimodal overlay
- Functional imaging fused onto a glioma
- Seizure prophylaxis: kept deliberately light
Anesthesia and positioning
- Anesthesia is what made this possible
- Induction and securing the airway
- The scalp block: numbing the outside
- Head fixation and asleep maintenance
- Modifications for the intraoperative MRI suite
Brain mapping: speech and motor
- The “tailored craniotomy”
- Tailored craniotomy around a glioblastoma
- What negative mapping taught us
- Why negative mapping is not a failure
- Speech mapping in practice
- Speech stimulation parameters
- Cortical and subcortical stimulation instruments
- How long does it take?
- Timing and patient fatigue
- Finding the motor strip: SSEP phase reversal
- Continuous motor-evoked potentials (CMEPs)
- Subcortical mapping and the 1 mA = 1 mm rule
- You get a muscle twitch while subcortical mapping at 3 mA. How close is the motor tract?
- Reading the signals to predict deficits
Managing complications
- Intraoperative seizures
- Intraoperative neurological decline (IND)
- Subcortical injury and diffusion-weighted imaging
Tumor resection and recovery
- En bloc versus piecemeal resection
- En bloc resection of a frontal astrocytoma
- How close can you cut? Resection margins
- Subcortical mapping of a parietal glioma
- Postoperative management
- Insular gliomas: a special postoperative caution
- The recovery timeline
- The team behind the patient
- Key takeaways
- References (1/2)
- References (2/2)
- Neurosurgical Operative Atlas: Neuro-Oncology