The surgical team awake
To date, “awake surgery” is the most reliable technique for assisting the surgeon in localizing personalized functional limits. An intervention in “awake conditions” takes place in three stages:
- approach to the lesion. The patient is under hypno-sedation.
- determining the functional limits of the resection. This is the phase during which the patient is awakened and performs continuous tests, under the supervision of a speech therapist. This means that motor, language, visual, spatial and calculation functions can be constantly monitored…. The surgeon uses an electrical probe to transiently disturb the stimulated area: if the patient can no longer perform the task during stimulation, the area must be preserved (see video http://www.college-de-france.fr/site/nicholas-ayache/seminar-2014-05-27-17h30.htm). Limits are thus identified, both on the surface and at depth.
- closure of the approach. The patient is again sedated (put back to sleep).
Given that excision is performed as close as possible to functional areas, it is not uncommon for patients to experience cognitive problems in the immediate postoperative period. An early speech and language assessment helps to identify them, and to direct the rehabilitation sessions, initially in Pr Yelnik’s rehabilitation department at Fernand-Widal Hospital, then on an outpatient basis, with a local speech and language therapist. Recovery is usually complete, after a variable period of around 4 months (between 1 month and 1 year). Overall, in the Lariboisière series, 80% of patients were able to return to work after awake surgery for low-grade glioma.
The surgical activity relies on the cohesion of an entire team, including surgeons, anesthetist, nurse anesthetist, neuroradiologists, speech therapists, neuropsychologist and rehabilitation physician. The team, led by Professor Mandonnet, includes :
- an anesthesia section, with Professor Etienne Gayat, Dr Charlotte Levé, Dr Ambre Tiepolo and Dr Raphaëlle Galy and nurse anesthetists Sylvie Aubrun, Séverine Levavaseur, Astrid Letertre;
- Speech therapy, with Isabelle Poisson, Marion Barberis and Cécile Prevost;
- a neuroradiological section, with Dr Antoine Guillonnet and Dr Morgane Lespagnol;
- a rehabilitation section, with Doctor Tlili, in the physical medicine and rehabilitation department of the Fernand Widal hospital;