Introduction: Seizures are a common presenting symptom of patients with brain tumors. Intraoperative seizures during awake craniotomy (AC) may result in failure to adequately monitor the patient. This study assessed the association between tumor location and the occurrence of intraoperative seizure during AC and their impact on patient outcome.
Methods: Data was prospectively collected of 122 consecutive patients who underwent AC for the removal of a brain tumor between 2010-2011. Demographic and clinical data such as age, Karnofsky Performance Score (KPS), history of seizures, intraoperative seizure occurrence, location of tumor, and extent of tumor resectionwere analyzed. Surgical outcome included inpatient death, postoperative complications, and length of stay.
Results: There were no significant differences between the three groups in the variables of gender, dominant side, KPS, extent of tumor resection, or history of seizures. Ten of 13 (71%) patients with tumors within the SMA region had a history of seizure, and 9 (69%) of them had experienced an intraoperative seizure. 27 of 59 (46%) patients with non-SMA frontal lobe tumors had a history of seizures and 13 of them (22%) experienced an intraoperative seizure. 22 of 50 (43%) patients with tumors located in non-frontal regions had seizure history and 5 (10%) had experienced an intraoperative seizure (p<0.0001 SMA vs. non-SMA frontal lobe and other regions). There were no significant differences between the three groups in the patients' outcome.
Conclusions: Patients with tumors located in the SMA had a significantly higher rate of intraoperative seizures during AC compared to patients with non-SMA frontal tumors and patients with tumors located in other regions of the brain. However, the occurrence of intraoperative seizures did not affect post-operative outcome.
Patient Care: This knowledge emphasize the need to be prepared during AC to the occurrence of intraoperative seizures, and may lead to a better outcome of these patients.
Learning Objectives: By the conclusion of this session, patients with tumors located in the SMA had a significantly higher rate of intraoperative seizures during AC compared to patients with tumors located in other regions of the brain. This observation calls for careful consideration and treatment during AC of patients with SMA associated tumors.