Article
Does the change in operative setup and technique facilitate safety and feasibility of awake craniotomy?
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Authors
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Nicolai El Hindy
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Essen der Universität Duisburg-Essen, Germany
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Dino Saban
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Essen der Universität Duisburg-Essen, Germany
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Bernd-Otto Hütter
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Essen der Universität Duisburg-Essen, Germany
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Oliver Müller
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Essen der Universität Duisburg-Essen, Germany
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Ulrich Sure
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Essen der Universität Duisburg-Essen, Germany
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Karsten Wrede
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Essen der Universität Duisburg-Essen, Germany
| Published: | June 8, 2016 |
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Outline
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Objective: Awake craniotomy (AC) for brain lesions facilitates safe removal of the lesion in or near eloquent brain area. Nevertheless, intraoperative seizures (IOSs) are reported as a cause of failure of AC. The aim of the present study was to investigate the impact of a change in operative setting and technique on safety and feasibility of AC and its implication on IOS and preservation of eloquent function.
Method: A retrospective analysis comprising all patients who underwent AC in our department between 2009 and 2015 was performed. During the whole time period AC was performed in an asleep-awake-asleep technique with preoperative functional MRI and the use of intraoperative neuronavigation. Intraoperative electrocorticography was not employed. Due to a change of mapping technique two groups were defined with group A exposing the primary motor area in order to evoke a motor response, indicating an optimal threshold of stimulation. In group B direct stimulation for language mapping was starting at 2 mA to a maximum of 10mA until speech arrest. After mapping the lesion was resected with the help of subcortical mapping and under continuous performance of tasks under the control of a neuropsychologist. Patients were prepared psychologically to increase intraoperative compliance. Both groups were compared with respect to basic clinical data, IOS, termination of AC and preservation of eloquent function. Statistical analyses were conducted using SPSS version 22.0 to determine significant associations.
Results: A total of 37 patients underwent AC, comprising 16 female and 21 male with a median age of 39 (range 21 -72 years). Groups did not differ with respect to age and sex. Interestingly, there was a significant difference regarding IOS with 4 (22.2%) in group A an none (0%) in group B (p=0.03). In group A, 3 of the 4 IOS ultimately led to abortion of AC. Altogether, AC had to be terminated in 6 (33.3%) patients in group A and 1 (5.3%) patient in group B (p=0.029). Preservation of eloquent function was achieved in 12 (67%) patients in group A and in 17 (89.5%) patients in group B.
Conclusions: AC can be safely performed without wide bone flap and dura mater opening to reach and stimulate the motor cortex unless necessary. It allows preservation of eloquent function with a low rate of IOS and termination of AC procedure.
