Experience of fully awake craniotomy for supratentorial lesions: a single-institution study

Abstract

AIM: To report and to discuss our experience of awake craniotomy for the treatment of supratentorial lesions. MATERIAL and METHODS:We included patients who underwent awake craniotomy for supratentorial tumors between 2007 and 2018. A bipolar stimulation probe was used for patients with eloquent area lesions. The demographic features, presenting symptoms, comorbidities, localization, histopathology, pre-and postoperative Karnofsky performance status, mean operation length, mean length of hospital stay, and intraoperative and postoperative complications were recorded. RESULTS:We included 250 patients (age, 53.5 ± 15.3 years; range, 15-90 years; 105 females and 145 males) mostly with metastasis (46%). The tumor resection rate was 90 ± 3.6%. Of 30 patients (12%) who experienced an increase in weakness, 26 experienced improvements within three days, and the remainder had permanent symptoms. Intraoperative and postoperative seizures occurred in three (1.2%) and seven (2.8%) patients, respectively, which were controlled by antiepileptic drugs. Dysphasia occurred intraoperatively in seven patients (2.8%) but improved in a month. The mean follow-up duration was 31.8 ± 11.9 months (range, 7-70 months). No mortality was seen during hospitalization.CONCLUSION: Awake procedures are a good option in supratentorial lesions to avoid the complications of general anesthesia for patients in poor medical condition. To obtain maximal tumor resection and to maintain better quality of life, neurosurgeons should opt for awake craniotomy when necessary.

Indication and eligibility of glioma patients for awake surgery: A scoping review by a multidisciplinary perspective

“…Another well-established exclusion criterion is the presence of psychiatric diseases such as psychotic or personality disorders, obsessive-compulsive disorder and depression ( 32 , 46 , 52 , 96 ). These elements can be assessed through the anamnestic recollection but, in case of doubts, specific questionnaires or scales can also be administered.…”

“…Anxiety is the most frequently assessed psychopathological disorder, including its different sub-types such as panic attacks and phobias ( 31 , 35 , 37 , 40 , 47 , 52 , 56 , 58 , 61 ). A careful examination of these aspects can predict the ability to control anxiety and fear related to AS.…”

“…Age was widely considered as a possible exclusion criterion, even if standardization is lacking: lots of works described AS for patients older than 60 ( 6 , 13 , 25 – 27 , 34 , 38 , 41 , 42 , 45 , 46 , 49 , 60 ) or than 70 years of age ( 33 , 35 , 39 , 47 , 53 , 56 , 58 , 61 , 64 – 66 , 96 ). In some cases, also elderly people were awakened ( 29 , 31 , 39 , 40 , 48 , 52 ). On the other hand, considering the pediatric population (< 18 years old), several works adopted AS for children and adolescents ( 6 , 24 , 25 , 29 , 32 , 33 , 39 , 43 , 48 , 50 , 52 ).…”

“…In some cases, also elderly people were awakened ( 29 , 31 , 39 , 40 , 48 , 52 ). On the other hand, considering the pediatric population (< 18 years old), several works adopted AS for children and adolescents ( 6 , 24 , 25 , 29 , 32 , 33 , 39 , 43 , 48 , 50 , 52 ).…”