Awake craniotomy versus surgery under general anesthesia for resection of intrinsic lesions of eloquent cortex—A prospective randomised study

• Published in: Clinical neurology and neurosurgery 2007-05, Vol.109 (4), p.335-343
• Main Authors: Gupta, Deepak Kumar, Chandra, P.S, Ojha, B.K, Sharma, B.S, Mahapatra, A.K, Mehta, V.S
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Anesthesia, General; Awake craniotomy; Biological and medical sciences; Brain Neoplasms - diagnosis; Brain Neoplasms - surgery; Cerebral Cortex - pathology; Cerebral Cortex - surgery; Craniotomy - methods; Dominance, Cerebral - physiology; Eloquent cortex; Female; Follow-Up Studies; Frontal Lobe - pathology; Frontal Lobe - surgery; Glioma; Glioma - diagnosis; Glioma - surgery; Humans; Intraxial lesions; Magnetic Resonance Imaging; Male; Medical research; Medical sciences; Middle Aged; Motor Cortex - pathology; Motor Cortex - surgery; Neurologic Examination; Neurology; Neurosurgery; Oxygen - blood; Postoperative Complications - diagnosis; Somatosensory Cortex - pathology; Somatosensory Cortex - surgery; Speech - physiology; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Temporal Lobe - pathology; Temporal Lobe - surgery; Tomography, X-Ray Computed; Treatment Outcome; Tumors; Wakefulness
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2007.01.008

Abstract Objectives Complete removal of a brain tumor without inflicting neurological deficits is a desirable end result in neurosurgical practice. Currently no prospective randomized surgical series in the literature exists comparing tumor resection under general versus local anesthesia awake surgery may achieve more aggressive tumor resection and minimize postoperative neurological morbidity. Patient and methods We thence conducted a prospective randomized comparative study of results of surgery under awake versus surgery under general anesthesia for intrinsic eloquent area lesions. Fifty-three patients with intrinsic brain tumors in eloquent areas were prospectively randomized (26 patients in awake group and 27 for surgery under general anesthesia). At 3 months follow up, 23% patients in awake group had permanent deficits compared to 14.8% in GA group. Results More than 90% tumor excision was observed in 57% patients in awake group versus 73.7% in GA group. Conclusions The mean operative time, blood loss was found to be was found to be less in GA group patients than in awake group. Better tumor cytoreduction, neurological improvement was seen in GA group (motor improvement in 35.7%, speech improvement in 62.5%) than in awake group patients (motor improvement in 18.7%, speech improvement in 14.3%).