Awake Craniotomy vs Surgery Under General Anesthesia for Resection of Supratentorial Lesions4

Author:

Sacko Oumar12,Lauwers-Cances Valérie3,Brauge David2,Sesay Musa4,Brenner Adam5,Roux Franck-Emmanuel12

Affiliation:

1. UMR Unité 825, Faculté Paul Sabatier, IFR 96

2. Pole Neurosciences, Centres Hospitalo-Universitaires de Toulouse, Toulouse, France

3. Service de Statistiques et d'Epidémiologie, Centres Hospitalo-Universitaires de Toulouse, Toulouse, France

4. Pole d'anesthesie, CHU Pellegrin, Bordeaux, France

5. Harrison Medical Center, Bremerton, Washington

Abstract

Abstract BACKGROUND: The use of an awake craniotomy in the treatment of supratentorial lesions is a challenge for both patients and staff in the operation theater. OBJECT: To assess the safety and effectiveness of an awake craniotomy with brain mapping in comparison with a craniotomy performed under general anesthesia. METHODS: We prospectively compared 2 groups of patients who underwent surgery for supratentorial lesions: those in whom an awake craniotomy with intraoperative brain mapping was used (AC group, n = 214) and those in whom surgery was performed under general anesthesia (GA group, n = 361, including 72 patients with lesions in eloquent areas). The AC group included lesions in close proximity to the eloquent cortex that were surgically treated on an elective basis. RESULTS: Globally, the 2 groups were comparable in terms of sex, age, American Society of Anesthesiologists score, pathology, size of lesions, quality of resection, duration of surgery, and neurological outcome, and different in tumor location and preoperative neurological deficits (higher in the AC group). However, specific data analysis of patients with lesions in eloquent areas revealed a significantly better neurological outcome and quality of resection (P < .001) in the AC group than the subgroup of GA patients with lesions in eloquent areas. Surgery was uneventful in AC patients and they were discharged home sooner. CONCLUSION: AC with brain mapping is safe and allows maximal removal of lesions close to functional areas with low neurological complication rates. It provides an excellent alternative to craniotomy under GA.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Clinical Neurology,Surgery

Reference19 articles.

1. Intraoperative brain mapping techniques in neurooncology;Berger;Stereotactic Funct Neurosurg,1992

2. Functional mapping-guided resection of low-grade gliomas;Berger;Clin Neurosurg,1995

3. Mapping the horizon: techniques to optimize tumor resection before and during surgery;Sanai;Clin Neurosurg,2008

4. Craniotomy under local anesthesia and monitored conscious sedation for the resection of tumors involving eloquent cortex;Danks;J Neurooncol,2000

5. Awake craniotomy with brain mapping as the routine surgical approach to treating patients with supratentorial intraaxial tumors: a prospective trial of 200 cases;Taylor;J Neurosurg,1999

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