SLU Surgeons Study 'Awake Aneurysm Surgery' for Better Outcomes
In a first time study published in the August edition of the Journal of Neurosurgery, Saint Louis University surgeons and researchers report that the use of conscious
sedation – also called “awake brain surgery” – allowed them to make adjustments mid-surgery
to lower risks during aneurysm surgery.
The research was led by Saleem Abdulrauf, M.D., chair of neurosurgery at Saint Louis
University and a SLUCare surgeon at SSM Health Saint Louis University Hospital. Abdulrauf
is encouraged by the results of this study, which he hopes can reduce the risks associated
with this type of brain surgery.
“Awake surgery for brain aneurysms may open a new frontier in neurosurgery that could
lead to improved outcomes and decreased risk,” says Abdulrauf. “This initial study
Surgeons use a technique called “clipping” to limit the damage of brain aneurysms,
weak areas in blood vessel walls that can bulge or rupture. In this procedure, patients
typically are given general anesthesia, the skull is opened by surgeons, and the artery
is clipped below the aneurysm to prevent it from bursting.
Ischemia – inadequate blood supply to a part of the body – is a significant risk during
this procedure that can cause neurological damage.
Abdulrauf and his team wanted to know if adding “awake” neurological testing to the
procedure could help limit this risk. Awake surgery, through conscious sedation, has
been used in neurosurgery in order for patients to maintain consciousness and communicate
with doctors, giving surgeons “real time” information to see how their patients’ brains
are functioning during a surgery.
In the current study, 30 patients with aneurysms that had not burst were given awake
neurological testing during their procedure. Three patients developed symptoms of
neurological deterioration during the course of surgery. Because the use of conscious
sedation allowed the surgery team to communicate with these patients and note the
nature of the neurological symptoms, the surgeons were able to make adjustments during
surgery and eliminate the neurological symptoms that were being cause by lack of blood
The researchers concluded that these patients benefited from the awake neurological
testing by decreasing their risk of ischemic injury. Though more study is needed,
the team is pleased that the study shows an avenue to explore as they aim to reduce
risks associated with this type of brain surgery.
Other authors on the Saint Louis University study include Peter Vuong, M.D., Ritesh
Patel, M.D., Raghu Sampath, M.D., Ahmed M. Ashour, M.D., Lauren M. Germany, B.S., Jonathon
Lebovitz, M.D., Colt Brunson, D.O., Yuvraj Nijjar, M.D., J. Kyle Dryden, D.O., Maheen
Q. Khan, M.D., Mihaela G. Stefan, M.D., Evan Wiley, M.D., Ryan T. Cleary, B.S., M.A., Connor
Reis, B.S., Jodi Walsh, R.N., B.S.N., and Paula Buchanan, Ph.D., MPH.
SLUCare Physician Group
SLUCare Physician Group is the academic medical practice of Saint Louis University,
with more than 500 health care providers and 1,200 staff members in hospitals and
medical offices throughout the St. Louis region. SLUCare physicians are among the
most highly trained in their fields - more than 50 specialties in all - and are national
and international experts, renowned for research and innovations in medicine.
Saint Louis University School of Medicine
Established in 1836, Saint Louis University School of Medicine has the distinction
of awarding the first medical degree west of the Mississippi River. The school educates
physicians and biomedical scientists, conducts medical research, and provides health
care on a local, national and international level. Research at the school seeks new
cures and treatments in five key areas: cancer, liver disease, heart/lung disease,
aging and brain disease, and infectious diseases.
SSM Health Saint Louis University Hospital
SSM Health (www.ssmhealth.com) is a Catholic, not-for-profit health system serving
the comprehensive health needs of communities across the Midwest through one of the
largest integrated delivery systems in the nation.
SSM Health Saint Louis University Hospital is a 356-bed quaternary and tertiary hospital
specializing in organ transplants and home of the Mid-America Stroke Network. A teaching
hospital, SSM Health Saint Louis University Hospital is home to SLUCare physicians
and students of Saint Louis University Medical School. An ACS Level I trauma center
for both Missouri and Illinois, Saint Louis University Hospital is accredited by the
Joint Commission and designated as a Primary Stroke Center.