Awake Craniotomy vs Craniotomy Under General Anesthesia for Perirolandic Gliomas: Evaluating Perioperative Complications and Extent of Resection

Eseonu, Chikezie I.; Rincón-Torroella, Jordina; ReFaey, Karim; Lee, Young M.; Nangiana, Jasvinder; Vivas-Buitrago, Tito

doi:10.1093/neuros/nyx023

Cited by 140 publications

(119 citation statements)

References 55 publications

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“…Awake craniatomy (AC) is a method that maintains patient awake during the surgical operation that can be carried out using a neuronavigation system, such as the Stealth Station developed by Medtronic (Parney et al, 2010 ). Compared with general anesthesia, AC leads to better GBM tumor resection and postoperative functional status, and to reduction in morbidity (Eseonu et al, 2017 ). Furthermore, AC enables to decrease hospitalization time by 3 days, hence reducing the cost of a surgical operation (Eseonu et al, 2017 ).…”

Section: The Different Gbm Treatments Commercialized or Under Developmentioning

confidence: 99%

“…Compared with general anesthesia, AC leads to better GBM tumor resection and postoperative functional status, and to reduction in morbidity (Eseonu et al, 2017 ). Furthermore, AC enables to decrease hospitalization time by 3 days, hence reducing the cost of a surgical operation (Eseonu et al, 2017 ). However, AC remains relatively complex to achieve, requiring the presence of a multidisciplinary team composed of surgeons, anesthesiologists, and neurologists.…”

Section: The Different Gbm Treatments Commercialized or Under Developmentioning

confidence: 99%

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Glioblastoma Treatments: An Account of Recent Industrial Developments

Alphandéry

2018

Front. Pharmacol.

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The different drugs and medical devices, which are commercialized or under industrial development for glioblastoma treatment, are reviewed. Their different modes of action are analyzed with a distinction being made between the effects of radiation, the targeting of specific parts of glioma cells, and immunotherapy. Most of them are still at a too early stage of development to firmly conclude about their efficacy. Optune, which triggers antitumor activity by blocking the mitosis of glioma cells under the application of an alternating electric field, seems to be the only recently developed therapy with some efficacy reported on a large number of GBM patients. The need for early GBM diagnosis is emphasized since it could enable the treatment of GBM tumors of small sizes, possibly easier to eradicate than larger tumors. Ways to improve clinical protocols by strengthening preclinical studies using of a broader range of different animal and tumor models are also underlined. Issues related with efficient drug delivery and crossing of blood brain barrier are discussed. Finally societal and economic aspects are described with a presentation of the orphan drug status that can accelerate the development of GBM therapies, patents protecting various GBM treatments, the different actors tackling GBM disease, the cost of GBM treatments, GBM market figures, and a financial analysis of the different companies involved in the development of GBM therapies.

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Section: The Different Gbm Treatments Commercialized or Under Developmentioning

confidence: 99%

Section: The Different Gbm Treatments Commercialized or Under Developmentioning

confidence: 99%

Glioblastoma Treatments: An Account of Recent Industrial Developments

Alphandéry

2018

Front. Pharmacol.

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“…The software, OsiriX (Pixmeo), was used to calculate the tumor area of each coronal cut (1.5-3.0 mm), and the sum of these values determined the volume, as we have previously described, by a clinician who was blinded to the cohorts. [11][12][13][14] The EOR was calculated based on the formula (preoperative volume À postoperative volume)/preoperative volume.…”

Section: Postoperative Managementmentioning

confidence: 99%

Comparative Cost Analysis of Endoscopic versus Microscopic Endonasal Transsphenoidal Surgery for Pituitary Adenomas

et al. 2017

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This study presents a comparative analysis of cost efficacy between the microscopic and endoscopic transsphenoidal approaches, evaluating neurological outcome, extent of resection (EOR), and inpatient hospital costs. This study was a retrospective chart review. This study was conducted at a tertiary care center. The study group consisted of 68 patients with transsphenoidal surgeries between January 2007 and January 2014. Two-sample -tests and Pearson's chi-square test evaluated inpatient costs, quality-adjusted life years (QALYs), volumetric EOR, and neurological outcomes. Total inpatient costs per patient was $22,853 in the microscopic group and less ($19,736) in the endoscopic group ( = 0.049). Operating room costs were $5,974 in the microscopic group and lower in the endoscopic group ($5,045; = 0.038). Operative time was 203.6 minutes in the microscopic group and 166.3 minutes in the endoscopic group ( = 0.032). The QALY score, length of hospital stay, and postoperative outcomes were found to be similar between the two cohorts. Multivariate linear regression modeling suggested that length of stay ( < 0.001) and operative time ( = 0.008) were important factors that influenced total inpatient costs following transsphenoidal surgery. This study shows that transsphenoidal surgery is more cost effective with the endoscopic approach than with the microscopic approach and depends on efficiency in the operating room as well as reduction in the length of hospitalization.

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“…The OsiriX software (Pixmeo) was used to determine the tumor volume by a clinician blinded to the cohorts, as we have previously described. 4,5,14,15 The postoperative tumor volume was calculated using the MR images that were obtained 48 hours after surgery using the previously described methods. The extent of resection was calculated based on the formula (preoperative tumor volume − postoperative tumor volume)/preoperative tumor volume.…”

Section: Tumor Volumetricsmentioning

confidence: 99%

“…In contrast to the study by Dickinson et al, in our study, all of the patients who were readmitted had a preoperative seizure history; moreover, nearly half of our cohort (47%) had tumors near or involving the perirolandic motor region, which has been associated with higher perioperative seizure occurrence. 14,22,38…”

Section: Length Of Hospitalization and Readmissionmentioning

confidence: 99%

Comparative analysis of monotherapy versus duotherapy antiseizure drug management for postoperative seizure control in patients undergoing an awake craniotomy

Eseonu

Eguia

García

et al. 2018

Journal of Neurosurgery

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OBJECTIVE Postoperative seizures are a common complication in patients undergoing an awake craniotomy, given the cortical manipulation during tumor resection and the electrical cortical stimulation for brain mapping. However, little evidence exists about the efficacy of postoperative seizure prophylaxis. This study aims to determine the most appropriate antiseizure drug (ASD) management regimen following an awake craniotomy. METHODS The authors performed a retrospective analysis of data pertaining to patients who underwent an awake craniotomy for brain tumor from 2007 to 2015 performed by a single surgeon. Patients were divided into 2 groups, those who received a single ASD (the monotherapy group) and those who received 2 types of ASDs (the duotherapy group). Patient demographics, symptoms, tumor characteristics, hospitalization details, and seizure outcome were evaluated. Multivariable logistic regression was used to evaluate numerous clinical variables associated with postoperative seizures. RESULTS A total of 81 patients underwent an awake craniotomy for tumor resection of an eloquent brain lesion. Preoperative baseline characteristics were comparable between the 2 groups. The postoperative seizure rate was 21.7% in the monotherapy group and 5.7% in the duotherapy group (p = 0.044). Seizure outcome at 6 months' follow-up was assessed with the Engel classification scale. The duotherapy group had a significantly higher proportion of seizure-free (Engel Class I) patients than the monotherapy group (90% vs 60%, p = 0.027). The length of stay was similar, 4.02 days in the monotherapy group and 4.51 days in the duotherapy group (p = 0.193). The 90-day readmission rate was higher for the monotherapy group (26.1% vs 8.5% in the duotherapy group, p = 0.044). Multivariate logistic regression showed that preoperative seizure history was a significant predictor for postoperative seizures following an awake craniotomy (OR 2.08, 95% CI 0.56-0.90, p < 0.001). CONCLUSIONS Patients with a preoperative seizure history may be at a higher risk for postoperative seizures following an awake craniotomy and may benefit from better postoperative seizure control with postoperative ASD duotherapy.

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Awake Craniotomy vs Craniotomy Under General Anesthesia for Perirolandic Gliomas: Evaluating Perioperative Complications and Extent of Resection

Abstract: We show that AC can be performed with more frequent total resections, better postoperative KPS, shorter hospitalizations, as well as similar perioperative complication rates compared to surgery under GA for perirolandic, eloquent motor-region glioma.

Cited by 140 publications

References 55 publications

Glioblastoma Treatments: An Account of Recent Industrial Developments

Glioblastoma Treatments: An Account of Recent Industrial Developments

Comparative Cost Analysis of Endoscopic versus Microscopic Endonasal Transsphenoidal Surgery for Pituitary Adenomas

Comparative analysis of monotherapy versus duotherapy antiseizure drug management for postoperative seizure control in patients undergoing an awake craniotomy

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