Louisiana Via Research Day Book 2026

Clinical Research

Russel Wagner, OMS-I 1,2 ; Muhammad Awais Khan, MS4 1 ; Hannah Walsh, BS 1 ; Mikaeel Kassam, MS2 1 ; Usman Khan, MD 1 ; Melanie Fukui, MD 1 ; Julian Bailes, MD 1 ; Ben Dukes, MD 1 ; Jacopo Berardinelli, MD 1 ; Amin Kassam, MD 1 1 Intent Medical Group, Northwest Community Hospital; 2 VCOM-Louisiana 102 FULLY CONSCIOUS CRANIOTOMY: A FEASIBLE AND VERSATILE REAL-TIME APPROACH FOR INTRAOPERATIVE NEUROCOGNITIVE ASSESSMENT — A RETROSPECTIVE REVIEW OF 166 CASES

Context: Conventional awake craniotomy consists of asleep-awake-asleep (AAA) monitored anesthesia care (MAC) protocol usually with propofol sedation, where the patient emerges for functional testing during resection with direct electrical stimulation (DES) used to map eloquent cortex. However, this approach poses limitations: propofol impairs neurocognition, and DES carries seizure risk. To enhance reliability of intraoperative assessment of cognitive function, we transitioned to a propofol-free MAC protocol using dexmedetomidine and remifentanil, achieving a continuous state of consciousness throughout all surgical phases – Conscious Craniotomy (CC) paradigm. Unlike stimulation-based paradigms, we rely on real-time assessment of cognitive function by constant interaction with the patient. We implemented this fully conscious protocol across a wide range of intracranial pathologies to enhance safety, improve reliable real-time cognitive assessment, and preserve function. Objective: To evaluate the safety, adaptability, and efficacy of our CC protocol using spontaneous neurocognitive feedback

across a large, heterogeneous case series of 166 patients.

surgical duration was nearly ten hours (range 0.62–9.66 hours, median 3.6 hours), with resection phases alone lasting up to 5.47 hours. Only one case required conversion to general anesthesia due to preexisting severe anxiety. Conclusion: Our CC protocol is a safe and broadly applicable alternative to traditional awake techniques and reliance on DES. By preserving patient engagement throughout all surgical phases, avoiding propofol entirely and midazolam during resection phases, and enabling intraoperative neurocognitive feedback without DES, we achieved maximal safe resections while minimizing perioperative risk. This CC approach may redefine the eligibility and workflow for awake neurosurgery.

Methods: We retrospectively reviewed 166 fully conscious craniotomies performed from July 2022 to July 2025. Data collected included tumor pathology, location, American Society of Anesthesiologists (ASA) physical status score, tumor diameter, duration of surgery, and dexmedetomidine/remifentanil dosing across surgical phases. All patients underwent a propofol-free MAC protocol using dexmedetomidine and remifentanil, tailored case-by-case. Inclusion criteria required patients to have supratentorial pathology and sufficient emotional and cognitive capacity to participate in an awake intraoperative assessment. Results: Patients’ ages ranged from 24 to 90 years. ASA scores ranged from I to IV (median = III). Common pathologies included metastases (n=48), glioblastoma (n=40), and meningioma (n=28). Tumor locations spanned frontal (n=58), parietal (n=33), temporal (n=23), occipital (n=11), insular (n=2), intraventricular (n=5), and multiregional (n=26). The maximal

Clinical Research

IN THE PHOTO: Areeba Imran, Class of 2028

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2026 Research Recognition Day