Resection of intramedullary spinal cord tumor under awake anesthesia: A novel approach to minimize postoperative motor deficits
Ahsan Ali Khan1, Lukui Chen1, Xiaoyuan Guo1, Hong Wang1, Guojian Wu1, Jun Kong1, Ning Yin2
1 Department of Neurosurgery, Zhongda Hospital, Southeast University, Nanjing 210009, China;
2 Department of Anaesthesia, Zhongda Hospital, Southeast University, Nanjing 210009, China
Resection of intramedullary spinal cord tumor under awake anesthesia: A novel approach to minimize postoperative motor deficits
Ahsan Ali Khan1, Lukui Chen1, Xiaoyuan Guo1, Hong Wang1, Guojian Wu1, Jun Kong1, Ning Yin2
1 Department of Neurosurgery, Zhongda Hospital, Southeast University, Nanjing 210009, China;
2 Department of Anaesthesia, Zhongda Hospital, Southeast University, Nanjing 210009, China
摘要 Objective: To observe advantages and disadvantages of the resection of intramedullary spinal cord tumor under awake anesthesia. Methods: Two patients with intramedullary spinal cord tumor underwent resection under awake anesthesia and followed up post-operatibely for any motor deficits. Results: Patients who underwent tumor resection under awake (AAA) anesthesia combined with intraoperative NPM had no motor deficits postoperatively. More accurate and nondelayed responses were observed in the awake cycle of anesthesia and helped guide surgery, thus avoiding injuries to the spinal cord. Conclusion: Intramedullary spinal cord tumors are not common, but only gross total resection (GTR) can provide complete remission of symptoms and progression-free survival. However, GTR sometimes results in motor function deficits postoperatively, particularly when the cervical cord is involved, and especially if surgery is done under general anesthesia with intraoperative neurophysiological monitoring (NPM) alone, because of delayed sensory evoked potential and motor evoked potential responses. We present two cases that underwent GTR of cervical intramedullary spinal cord tumors under an asleep-awake-asleep (AAA) cycle of anesthesia, combined with intraoperative NPM in which no post-operative motor deficits were observed on 6-months hs follow up.
Abstract: Objective: To observe advantages and disadvantages of the resection of intramedullary spinal cord tumor under awake anesthesia. Methods: Two patients with intramedullary spinal cord tumor underwent resection under awake anesthesia and followed up post-operatibely for any motor deficits. Results: Patients who underwent tumor resection under awake (AAA) anesthesia combined with intraoperative NPM had no motor deficits postoperatively. More accurate and nondelayed responses were observed in the awake cycle of anesthesia and helped guide surgery, thus avoiding injuries to the spinal cord. Conclusion: Intramedullary spinal cord tumors are not common, but only gross total resection (GTR) can provide complete remission of symptoms and progression-free survival. However, GTR sometimes results in motor function deficits postoperatively, particularly when the cervical cord is involved, and especially if surgery is done under general anesthesia with intraoperative neurophysiological monitoring (NPM) alone, because of delayed sensory evoked potential and motor evoked potential responses. We present two cases that underwent GTR of cervical intramedullary spinal cord tumors under an asleep-awake-asleep (AAA) cycle of anesthesia, combined with intraoperative NPM in which no post-operative motor deficits were observed on 6-months hs follow up.
Ahsan Ali Khan, Lukui Chen, Xiaoyuan Guo, Hong Wang, Guojian Wu, Jun Kong, Ning Yin. Resection of intramedullary spinal cord tumor under awake anesthesia: A novel approach to minimize postoperative motor deficits[J]. 临床转化神经科学, 2017, 3(1): 28-34.
Ahsan Ali Khan, Lukui Chen, Xiaoyuan Guo, Hong Wang, Guojian Wu, Jun Kong, Ning Yin. Resection of intramedullary spinal cord tumor under awake anesthesia: A novel approach to minimize postoperative motor deficits. Translational Neuroscience and Clinics, 2017, 3(1): 28-34.
20170512093634 Figure 1 a–c. Preoperative MR images of Case 1.
20170512093647 Figure 2 a–c. Postoperative MR images of Case 1.
20170512093703 Figure 3 a–c. Preoperative MR images of Case 2.
20170512093715 Figure 4 a–c. Postoperative MR images of Case 2.
20170512093728 Table 1 Pharmacological agents used for anesthesia induction and AAA cycle.
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2017, Vol. 3 
