Awake Craniotomy vs Craniotomy Under General Anesthesia for Perirolandic Gliomas: Evaluating Perioperative Complications and Extent of Resection
- 15 March 2017
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Neurosurgery
- Vol. 81 (3), 481-489
- https://doi.org/10.1093/neuros/nyx023
Abstract
BACKGROUND: A craniotomy with direct cortical/subcortical stimulation either awake or under general anesthesia (GA) present 2 approaches for removing eloquent region tumors. With a reported higher prevalence of intraoperative seizures occurring during awake resections of perirolandic lesions, oftentimes, surgery under GA is chosen for these lesions. OBJECTIVE: To evaluate a single-surgeon's experience with awake craniotomies (AC) vs surgery under GA for resecting perirolandic, eloquent, motor-region gliomas. METHODS: Between 2005 and 2015, a retrospective analysis of 27 patients with perirolandic, eloquent, motor-area gliomas that underwent an AC were case-control matched with 31 patients who underwent surgery under GA for gliomas in the same location. All patients underwent direct brain stimulation with neuromonitoring and perioperative risk factors, extent of resection, complications, and discharge status were assessed. RESULTS: The postoperative Karnofsky Performance Score (KPS) was significantly lower for the GA patients at 81.1 compared to the AC patients at 93.3 (P = .040). The extent of resection for GA patients was 79.6% while the AC patients had an 86.3% resection (P = .136). There were significantly more 100% total resections in the AC patients 25.9% compared to the GA group (6.5%; P = .041). Patients in the GA group had a longer mean length of hospitalization of 7.9 days compared to the AC group at 4.2 days (P = .049). CONCLUSION: We show that AC can be performed with more frequent total resections, better postoperative KPS, shorter hospitalizations, as well as similar perioperative complication rates compared to surgery under GA for perirolandic, eloquent motor-region glioma.Keywords
This publication has 52 references indexed in Scilit:
- Awake craniotomy and electrophysiological mapping for eloquent area tumoursClinical Neurology and Neurosurgery, 2013
- Cost-utility of maximal safe resection of WHO grade II gliomas within eloquent areasActa Neurochirurgica, 2012
- Analysis of Propofol/Remifentanil Infusion Protocol for Tumor Surgery With Intraoperative Brain MappingJournal of Neurosurgical Anesthesiology, 2010
- Outcome of fully awake craniotomy for lesions near the eloquent cortex: analysis of a prospective surgical series of 79 supratentorial primary brain tumors with long follow-upActa Neurochirurgica, 2009
- Predictors of Cognitive Dysfunction after Major Noncardiac SurgeryAnesthesiology, 2008
- Type and Severity of Cognitive Decline in Older Adults after Noncardiac SurgeryAnesthesiology, 2008
- Prospective study of awake craniotomy used routinely and nonselectively for supratentorial tumorsJournal of Neurosurgery, 2007
- Anesthetic Complications of Awake Craniotomies for Epilepsy SurgeryAnesthesia & Analgesia, 2006
- Awake Craniotomy for Aggressive Resection of Primary Gliomas Located in Eloquent BrainMayo Clinic Proceedings, 2001
- Conscious-sedation analgesia during craniotomy for intractable epilepsy: a review of 354 consecutive casesCanadian Journal of Anesthesia/Journal canadien d'anesthésie, 1988