gms | German Medical Science

Objective: Resection of glioma is the most influential factor on survival. Awake surgery with functional mapping is performed to achieve total resection while avoiding deficits. The technique seems to be well tolerated, despite potential distress it might induce. Data on patients' perception is limited. We performed an audit to assess the impact of the procedure and identify aspects for improvement.

Methods: We enrolled 71 patients (37 male, 34 female; mean age 49 years, range 21–76 years). Pain and discomfort were measured during awake phase. Data on patient characteristics and protocol (head fixation, positioning, medication, airway, monitoring technique, intraoperative seizures, histology) was collected. Postoperatively, patients answered 7 questions on preparation prior to surgery, memory, fear and distress, sensations during mapping and length of surgery. Descriptive statistical analyses were performed.

Results: Histology revealed WHO grade II glioma in 21, WHO grade III in 20 and WHO grade IV in 30 cases. We used an asleep-awake-asleep protocol. Mean length of awake phase was 45 minutes (range 20–75 minutes). Seizures occurred in 4 cases (5.6%) during electrical stimulation. Pain levels on visual analogue scale were 1.7 cm (range 0–7.0 cm) at the beginning, 2.4 cm (range 0–7.0 cm) in the middle and 2.6 cm (range 0–10.0 cm) at the end of awake phase. Corresponding levels of anxiety were 2.5 cm (range 0–10 cm), 3.2 cm (range 0–10 cm) and 3.5 cm (range 0–10 cm), respectively. No significant differences were found when analyzing the impact of patient characteristics. Patient questionnaire revealed that awake surgery is mainly tolerated without concern. Discomfort resulted from head fixation or painful positioning. 3 patients would never again undergo awake surgery.

Conclusions: We demonstrate that awake surgery is very well tolerated by patients, as neither intraoperative nor postoperative assessment revealed major disadvantages. Concerning practical lessons learned from this audit, we emphasize the importance of minimizing pain and preparing patients thoroughly to reduce anxiety and maximize cooperation. In our experience awake surgery is thus an excellent treatment modality for supratentorial brain tumors, regardless of histology, with very positive perception by patients.