Introduction: Despite recent advances in the use of functional magnetic resonance imaging (fMRI) and tractography during preoperative planning, awake craniotomy remains the technique of choice when manipulating lesions involving eloquent cortex. Its ability to provide real time feedback makes it the most reliable method to ensure neurological integrity during resection of highly infiltrating tumors like glioblastoma. A potential complication of this approach is emergence delirium during the awake portion, which if not resolved may lead to suboptimal resection. Risk factors for delirium during awake craniotomy remain unknown.
Methods: We retrospectively reviewed 116 instances of awake craniotomy for glioblastoma resection at Duke University Medical Center between January 2009 and March 2010. Patients were categorized as either agitated or non-agitated based on intra-operative reports; ambiguous terminology such as ‘uncooperative’ warranted exclusion from the agitated cohort. Resulting cohorts were analyzed for predictors of emergence delirium according to age, gender, weight, height, BMI, past medical and medication history. Data was analyzed using ordinal logistic regression and the Fisher’s exact test.
Results: Of 116 patients who underwent awake craniotomy, 8 experienced emergence delirium. This translated into an incidence of 7% (CI, 3.5 – 13.0%). Comparison between the two cohorts revealed pre-existing hypertension (62.50 vs. 25.93%, p=0.0408), elevated BMI (32.21±4.86 vs. 26.15±4.93 kg/m2, p=0.0057) and increased weight (102.21±15.56 vs. 77.53±15.38 kg, p=0.0009) to all be predisposing factors for emergence delirium (Table 1). Statins were more frequently prescribed (50.00 vs. 12.96%, p=0.0196) to patients developing emergence delirium (Table 2).
Conclusions: The incidence of emergence delirium during awake craniotomy at DUMC is 7%, which is likely to be an underestimation. Conditions predisposing to emergence delirium during awake craniotomy included pre-existing hypertension, high BMI, and increased weight. Drug regimens of patients developing delirium more frequently included statins. Hopefully, identification of risk factors for emergence delirium during awake craniotomy can improve preoperative management and postsurgical outcomes for glioblastoma patients.
Patient Care: By identifying risk factors for emergence delirium during awake craniotomy improvements can be made to the preoperative management of patients undergoing awake craniotomy for glioblastoma resection. Therefore, improving outcomes by avoiding the complications associated with intraoperative emergence delirium.
Learning Objectives: By the conclusion of this session, participants should be able to 1) Identify risk factors for emergence delirium during awake craniotomy, 2) Identify medications predisposing patients to delirium during awake craniotomy