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67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

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Neurological and radiological outcome after awake craniotomy for lesions in or adjacent to eloquent brain areas

Meeting Abstract

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  • Karsten H. Wrede - Klinik für Neurochirurgie, Universitätsklinik Essen, Essen, Germany
  • Andreas Kneist - Klinik für Neurochirurgie, Universitätsklinik Essen, Essen, Germany
  • Bernd-Otto Hütter - Klinik für Neurochirurgie, Universitätsklinik Essen, Essen, Germany
  • Oliver Müller - Klinik für Neurochirurgie, Universitätsklinik Essen, Essen, Germany
  • Ulrich Sure - Klinik für Neurochirurgie, Universitätsklinik Essen, Essen, Germany
  • Nicolai El Hindy - Klinik für Neurochirurgie, Universitätsklinik Essen, Essen, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocP 023

doi: 10.3205/16dgnc398, urn:nbn:de:0183-16dgnc3986

Published: June 8, 2016

© 2016 Wrede et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Resection of lesions in or adjacent to eloquent brain areas has been performed using awake craniotomy (AC) over many decades. This retrospective study analyzes the neurological and radiological outcome after AC in a contemporary patient series.

Method: Basic demographic data of all consecutive patients (n = 39) who underwent AC (n = 40) in our center between February 2009 and October 2015 was collected from our continuously maintained database. Additionally, tumor location, lateralization, pre- and postoperative neurological deficits and Glasgow outcome score were included in the analysis. All patients underwent functional MRI mapping prior to microsurgical removal in a sleep-awake-sleep technique. Extent of resection was classified as gross total resection (GTR) or subtotal resection (STR) on early postoperative MRI images. Statistical analysis (chi square test, Wilcoxon matched-pairs signed-rank test) was carried out with the STATA software package (Stata/MP 14.1 for Linux 64-bit).

Results: The study group comprised 24 (61.5%) male and 15 (38.5%) female patients (p = 0.1495) with an average age of 41.1 years (standard error of the mean (SEM) 1.88, range 21 - 72). One patient underwent AC for primary surgery and tumor recurrence. Lateralization was significantly (p < 0.001) more on the left (n = 35) than on the right (n = 5) side. Eloquent areas indicating AC were as follows: Broca (n = 23), Wernicke (n = 7) and central cortex (n = 10). Preoperatively 23 (59%) patients had no focal neurological deficit. Transient new neurological deficits were observed in 6 (15.4%) patients and 4 (10.3%) patients suffered permanent neurological impairment. Glasgow outcome scores were as follows: preoperative 4.8 (SEM 0.07), early postoperative 4.25 (SEM 0.13) and late postoperative 4.6 (SEM 0.11). There was no significant difference between preoperative and late postoperative scores (p = 0.0762). Gross total resection was achieved in 24 and subtotal resection was achieved in 16 cases (p = 0.2059).

Conclusions: Awake craniotomy allows safe microsurgical removal of intractable lesions in or adjacent to eloquent brain areas when removal under general anesthesia was unreasonably hazardous. Neurological and radiological outcome was excellent for the majority of cases.