Introduction: Awake craniotomy is an important surgical technique for operating tumor in eloquent areas. With meticulous case selection, it helps us to reduce the morbidity associated with operating such tumor. This study was done to examine the morbidity as well as the extent of resection in patients with gliomas undergoing awake craniotomy, using clinical monitoring.
Methods: A database of patients undergoing awake craniotomy was prospectively maintained since 2007.All patients with tumor close to eloquent areas were counseled for undergoing awake craniotomy. Whenever possible, a functional MRI was obtained with the routine MRI. The patients underwent surgery with scalp block, sometimes supplemented with injectable dexmedetomidine. The patients were monitored clinically during the surgery for speech and motor deficits. Electrophysiological monitoring was not used during the procedure. Intra-operative complications like seizure, motor and speech deficits were recorded. Surgeon’s impression of extent of resection was recorded. A post operative imaging (CT/MRI) was obtained to check the resection status. The course in wards and condition at discharge was recorded.
Results: 52 patients including 39 males and 13 females underwent awake craniotomy at our centre. Peri-rolandic location was the most frequent site (69.5%) and high grade gliomas was the most common histological group (71.2%).Intra-operative ultrasound was used in 84.6% of cases during surgery .25 patient (48.1%) of patients had deficits at presentation.19 Patients(36.5%) developed new deficits during surgery. These deficits improved partially or completely in 63 % of patients at discharge.51.9% of patients had gross total excision at surgery and 51.9 % of patients had gross total resection on imaging studies. The results are comparable with available literature.
Conclusions: Awake craniotomy with clinical monitoring can be used in suitable patients with tumors in eloquent areas with acceptable morbidity and extent of resection, especially at centers where electrophysiological monitoring is unavailable.
Patient Care: Help smaller centres to perform safe surgeries in eloquent area gliomas
Learning Objectives: This study higlights that awake craniotomy with clinical monitoring can be used in any small centre without electrophysiological monitoring and with the help of intra-operative ultrasound, helps us to achieve better resection in eloquent area gliomas.