• Christian Ott, Christoph Kerscher, Ralf Luerding, Christian Doenitz, Julius Hoehne, Nina Zech, Milena Seemann, Juergen Schlaier, and Alexander Brawanski.
• *Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany; ‡Department of Anaesthesiology, University Medical Centre Regensburg, Regensburg, Germany; §Department of Neurology, University Medical Centre Regensburg, Regensburg, Germany; ¶Department of Neurosurgery, University Medical Centre Regensburg, Regensburg, Germany.
• Neurosurgery. 2014 Aug 1;75(2):117-23; discussion 123; quiz 123.

BackgroundDuring awake craniotomies, patients may either be awake for the entire duration of the surgical intervention (awake-awake-awake craniotomy, AAA) or initially sedated (asleep-awake-asleep craniotomy, SAS).ObjectiveTo examine whether prior sedation in SAS may restrict brain mapping, we conducted neuropsychological tests in patients by means of a standardized anesthetic regimen comparable to an SAS.MethodsWe prospectively examined patients undergoing surgery either under total intravenous anesthesia (TIVA) or under regional anesthesia with slight sedation (RAS). The tests included the DO40 picture-naming test, the digit span, the Regensburg Word Fluency Test, and the finger-tapping test. Each test was conducted 3 times for every patient in the TIVA and RAS groups, once before surgery and twice within about 35 minutes after the end of sedation. Patients undergoing AAA were examined preoperatively and intraoperatively.ResultsIn the AAA group, no significant difference was found between preoperative and intraoperative test results. In the TIVA and RAS groups, postoperative tests showed worse results than preoperative tests. In most tests, patients improved from the first to the second postoperative test.ConclusionCognitive and motor performance were significantly influenced by prior sedation in the TIVA and RAS groups, but not in the AAA group. Therefore, prior sedation may be assumed to cause a change in the baselines, which may compromise brain mapping and thus endanger a patient's neurological outcome in the case of an SAS.

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