Awake craniotomy versus surgery under general anesthesia for resection of intrinsic lesions of eloquent cortex--a prospective randomised study

Clin Neurol Neurosurg. 2007 May;109(4):335-43. doi: 10.1016/j.clineuro.2007.01.008. Epub 2007 Feb 14.

Abstract

Objectives: Complete removal of a brain tumor without inflicting neurological deficits is a desirable end result in neurosurgical practice. Currently no prospective randomized surgical series in the literature exists comparing tumor resection under general versus local anesthesia awake surgery may achieve more aggressive tumor resection and minimize postoperative neurological morbidity.

Patient and methods: We thence conducted a prospective randomized comparative study of results of surgery under awake versus surgery under general anesthesia for intrinsic eloquent area lesions. Fifty-three patients with intrinsic brain tumors in eloquent areas were prospectively randomized (26 patients in awake group and 27 for surgery under general anesthesia). At 3 months follow up, 23% patients in awake group had permanent deficits compared to 14.8% in GA group.

Results: More than 90% tumor excision was observed in 57% patients in awake group versus 73.7% in GA group.

Conclusions: The mean operative time, blood loss was found to be was found to be less in GA group patients than in awake group. Better tumor cytoreduction, neurological improvement was seen in GA group (motor improvement in 35.7%, speech improvement in 62.5%) than in awake group patients (motor improvement in 18.7%, speech improvement in 14.3%).

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anesthesia, General*
  • Brain Neoplasms / diagnosis
  • Brain Neoplasms / surgery*
  • Cerebral Cortex / pathology
  • Cerebral Cortex / surgery*
  • Craniotomy / methods*
  • Dominance, Cerebral / physiology
  • Female
  • Follow-Up Studies
  • Frontal Lobe / pathology
  • Frontal Lobe / surgery
  • Glioma / diagnosis
  • Glioma / surgery*
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Motor Cortex / pathology
  • Motor Cortex / surgery
  • Neurologic Examination
  • Oxygen / blood
  • Postoperative Complications / diagnosis*
  • Somatosensory Cortex / pathology
  • Somatosensory Cortex / surgery
  • Speech / physiology
  • Temporal Lobe / pathology
  • Temporal Lobe / surgery
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Wakefulness*

Substances

  • Oxygen