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  • Awake Craniotomy Versus Craniotomy Under General Anesthesia for Perirolandic Gliomas: a Single-Surgeon, Single-institution, Ten-year Experience Evaluating Perioperative Complications and Extent of Res

    Final Number:

    Chikezie Eseonu MD; Jordina Rincon-Torroella MD; karim ReFaey; Young Min Lee MD, BSPH; Jasvinder S. Nangiana MD; Alfredo Quinones-Hinojosa MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: An awake craniotomy (AC) and surgery under general anesthesia (GA) present two approaches for removing perirolandic, motor area gliomas. With a reported higher prevalence of intraoperative seizures occurring during awake resections of perirolandic lesions, oftentimes, surgery under general anesthesia is chosen for these lesions. This study evaluates a single-surgeon's experience with awake craniotomies versus surgery under general anesthesia for resecting perirolandic, motor area gliomas.

    Methods: A comparative univariate analysis between 31 patients who had a craniotomy under general anesthesia (GA) with neuromonitoring and direct cortical stimulation (DCS) versus 27 patients who underwent an awake craniotomy (AC) with DCS for perirolandic gliomas was conducted. Perioperative risk factors, extent of resection, complications, and discharge status were assessed.

    Results: The two groups were comparable in terms of age, sex, preoperative Karnofsky Performance Status score, size of the lesions, tumor location, and postoperative neurological deficits. The postoperative KPS, months after surgery, was significantly lower for the GA patients at 81.1 compared to the AC patients at 93.3 (p=0.040). The extent of resection for GA patients was 79.6% while the AC patients had a 86.3% resection (p=0.136). There were significantly more 100% total resections in the AC patients 25.9% compared to the GA group (6.5%) (p=0.041). Patients in the GA group had a longer mean length of hospitalization of 7.9 days compared to the AC group which was 4.2 days (p=0.05). Stimulation-induced seizures occurred in 7.4% of AC cases and 16.1% of GA cases (p=0.432), with no aborted cases in either group.

    Conclusions: An awake craniotomy presents a safe, viable approach for perirolandic, eloquent region glioma resections. We show that awake craniotomies can be performed with low intraoperative seizure rates, more frequent 100% total resections, better postoperative KPS, shorter hospitalizations, as well as similar perioperative complication rates compared to surgery under general anesthesia.

    Patient Care: This study evaluates the efficacy and safety of awake craniotomies on perirolandic gliomas, thus allowing surgeons to choose the safest surgical approach for treating patients with eloquent region gliomas that can help improve surgical outcome and minimize length of hospitalization.

    Learning Objectives: 1) To understand the postoperative outcome differences between awake craniotomies versus surgery under general anesthesia for perirolandic gliomas 2) To identify surgical risks associated with awake craniotomies and surgery under general anesthesia 3) To evaluate the best surgical approach for perirolandic gliomas

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