Operative Strategies during Awake Surgery Affect Deterioration of Paresis a Month after Surgery for Brain Lesions in the Primary Motor Area

Abstract

We analyzed factors associated with worsened paresis at 1-month follow-up in patients with brain tumors located in the primary motor area (M1) to establish protocols for safe awake craniotomy for M1 lesions. Patients with M1 brain tumors who underwent awake surgery in our hospital ( = 61) were evaluated before, during, and immediately and 1 month after surgery for severity of paresis, tumor location, extent of resection, complications, preoperative motor strength, histology, and operative strategies (surgery stopped or continued after deterioration of motor function). Worsened paresis at 1-month follow-up was significantly associated with worsened paresis immediately after surgery and also with operative strategy. Specifically, when motor function deteriorated during awake surgery and did not recover within 5 to 10 minutes, no deterioration was observed at 1-month follow-up in cases where we stopped surgery, whereas 6 of 13 cases showed deteriorated motor function at 1-month follow-up in cases where we continued surgery. Stopping tumor resection on deterioration of motor function during awake surgery may help prevent worsened paresis at 1-month follow-up.

Comparison of the Asleep-Awake-Asleep Technique and Monitored Anesthesia Care During Awake Craniotomy: A Systematic Review and Meta-analysis

“…The risk of bias for the other nonrandomized studies was assessed using the Newcastle-Ottawa scale 27. We rated the quality of 4 studies as “good”7,29,30,37 and 12 as “poor.”17,35,36,38–46 The quality of evidence for every outcome measure in the studies comparing SAS with MAC was assessed using the GRADE approach28; full details are available in the Supplementary Material (Supplementary Digital Content 4, http://links.lww.com/JNA/A238: certainty assessment per outcome measures).…”

“…27 We rated the quality of 4 studies as "good" 7,29,30,37 and 12 as "poor." 17,35,36,[38][39][40][41][42][43][44][45][46] The quality of evidence for every outcome…”

“…Four RCTs, 16,18,33,34 4 prospective observational studies, 30,[35][36][37] 5 observational retrospective studies, [38][39][40][41][42] and 5 case series 17,[43][44][45][46] were included in the quantitative analysis (Table 1). Information about the anesthetic techniques used in each study is available in the Supplementary Material (Supplementary Digital Content 3, http://links.lww.com/JNA/A237: anesthetic techniques in the included studies).…”

Technical Aspects of Motor and Language Mapping in Glioma Patients

“…For example, permanent postoperative deficits have been reported in as few as 2% of AS cases when using adaptive high-frequency monopolar mapping [ 51 ], which is preferred in the asleep setting due to the variability of neuromonitoring measurements when the patient is awake [ 51 ]. On the other hand, in AC cases, continued resection past the point of failed recovery of an intraoperative deficit is associated with permanent deficits [ 55 ].…”