Awake craniotomy versus craniotomy under general anesthesia for the surgical treatment of insular glioma: choices and outcomes

Abstract

Objective: To investigate differences in outcomes in patients who underwent surgery for insular glioma using an awake craniotomy (AC) vs. a craniotomy under general anesthesia (GA). Methods:Data from patients treated at our hospital between 2005 and 2015 were analyzed retrospectively. The preoperative, intraoperative, postoperative, and longer term follow-up characteristics and outcomes of patients who underwent surgery for primary insular glioma using either an AC or GA were compared. Results: Of the 52 identified patients, 24 had surgery using an AC and 28 had surgery under GA. The extent of resection was similar for the two anesthesia techniques: the median extent of resection was 61.4% (IQR: 37.8-74.3%) in the WHO grade <4 AC group vs. 50.5% (IQR: 35.0-71.2%) in the grade <4 GA group and 73.4% (IQR: 54.8-87.2%) in the grade 4 AC group vs. 88.6% (IQR: 61.2-93.0%) in the grade 4 GA group. Consistent with literature, there were more early neurological deficits after an AC, while the GA group showed more new late neurological deficits; however, these trends were not significant. Survival was similar between the two groups, with 100% 1-and 2-year survival in the grade <4 groups. Conclusion: Our results showed that the extent of resection, neurological outcomes, and survival were similar using the two anesthesia techniques. Since AC is more challenging for the patient and for his or her caregiver after surgery, this finding has implications for clinical decision-making.

The Role of Intraoperative MRI in Awake Neurosurgical Procedures: A Systematic Review

“…Second, with the application of this combined technique, the extent of GTR appears to be in keeping with standard I-MRI studies, where patients were under general anesthesia ( 17 , 20 , 21 ) This result provides preliminary evidence to support the notion that awake craniotomy techniques during I-MRI cases do not limit the ability to obtain acceptable operative resections for intrinsic tumors. With appropriate anesthetic techniques, one can perform similar resections to patients under general anesthetics.…”

“…In order to improve the safety profile associated with extensive surgical resections, awake craniotomy techniques have been implemented, particularly in those lesions located in or near eloquent structures ( 16 ). Awake craniotomy is a commonly performed neurosurgical procedure for the resection of brain lesions near to an eloquent area ( 17 – 21 ). This technique increases the safety profile and potentially improves the overall neurological outcome of the patient ( 17 , 18 , 20 ).…”

Insular glioma surgery: an evolution of thought and practice

“…Awake craniotomy with cortical and subcortical stimulation mapping results in a lower rate of permanent neurological deficits compared with insular gliomas approached without mapping (19% neurological impairment rate for patients without mapping vs 4.3% with mapping, p = 0.008). 2,18 Furthermore, patients with WHO grade III-IV gliomas are more likely to experience long-term neurological deficits than those with WHO grade II gliomas. 42,45,49,51 With respect to location, short-term neurological complications occur most frequently following resection of zone 1 tumors and giant insular gliomas involving all 4 zones.…”

The effect of using awake craniotomy combined with multimodal techniques intraoperatively on the survival of patients with glioblastoma: A retrospective single-centre study

“…25 The rate of new neurological damage has been reported to be 18-23%. 26,27,28 In our study, 91% of patients had either improved or no change in their neurological status. Only 7 patients experienced new neurological dysfunction and a reduced KPS score after surgery, including worsening of their pre-existing neurological dysfunction.…”