Introduction: Surgical resection of intracerebral tumor can be achieved under general anesthesia (GA) or awake anesthesia (AA). The appeal of AA is that it facilitates intraoperative identification and avoidance of eloquent areas, thus preventing potential functional compromise. The aim of this meta-analysis was to compare the clinical outcomes of intracerebral tumor resection with AA versus GA.
Methods: Searches of seven electronic databases from inception to December 2017 were conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. There were 1037 articles identified for screening. Data were extracted and analyzed using meta-analysis of proportions.
Results: A total of 14 comparative studies were included for analysis. Compared to GA, resection performed under AA demonstrated significantly lower incidence of postoperative nausea and vomiting (PONV, OR, 0.17; 95% CI, 0.09 to 0.33; p<0.001; I2=0%) and shorter length of stay (LOS, MD, -1.76 days; 95% CI, -3.24 to -0.27 days; p=0.02; I2=95%). In terms of operative outcomes, resection outcomes, complications, and short- and long-term deficits, there was no statistically significant trend in favor of either approach.
Conclusions: AA is a feasible approach to resect intracerebral tumors. All reported clinical outcomes under AA were non-inferior, at the least, when compared to those performed under GA. Future studies that are larger, prospective, randomized, and include quality of life metrics will be helpful to delineate the role of AA in the management of patients with brain tumors.
Patient Care: Surgeons who are anxious about awake cranial surgery will be reassured by this analysis and feel comfortable offering their patients an awake option to mitigate neurological deficit and shorten length of stay after surgery
Learning Objectives: After this presentation, participants will be able to:
1. Describe evidence supporting awake anesthetic option for cranial neurosurgery
2. Understand the biases inherent in a meta-analysis