Comparison of Awake Craniotomy with Craniotomy Under General Anesthesia for Resection of Tumors in Eloquent Areas of Brain

Waqar Ahmed; Fazal hussain Fazal; Muhammad Saeed; Bilal yasin; M. Umair khan; Waqas Tariq

doi:10.51253/pafmj.v74i5.8764

Authors

Waqar Ahmed Department of Anaesthesia, Combined Military Hospital Okara/National University of Medical Sciences (NUMS) Pakistan
Fazal hussain Fazal Department of Anaesthesia, Combined Military Hospital Okara/National University of Medical Sciences (NUMS) Pakistan
Muhammad Saeed Department of Anaesthesia, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Bilal yasin Department of Anaesthesia, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
M. Umair khan Department of Anaesthesia, Combined Military Hospital Okara/National University of Medical Sciences (NUMS) Pakistan
Waqas Tariq Department of Anaesthesia, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v74i5.8764

Keywords:

Awake craniotomy, Brain tumors, General anesthesia.

Abstract

Objective: To compare awake craniotomy with craniotomy under general anesthesia for early post-operative parameters in patients undergoing resection of tumors in eloquent areas of brain.

Study Design: Quasi experimental study.

Place and Duration of Study: Department of Anesthesia, Combined Military Hospital, Rawalpindi Pakistan Apr 2021 to May 2022.

Methodology: All the patients who underwent resection surgeries for brain tumors in eloquent areas of brain were included in the study. They were divided into two Groups via lottery method. Group A underwent awake craniotomy while Group B underwent craniotomy under general anesthesia. Relevant intraoperative and early post-operative parameters were compared in both the Groups.

Results: A total of 60 patients who underwent resection of eloquent area brain tumors in our hospital during the study period were included in the final analysis. Out of these 40(66.7%) underwent craniotomy under general anesthesia while 20(33.3%) underwent awake craniotomies. Mean age of the study participants was 45.61±7.889 years. Frontal lobe tumors were the most encountered brain tumors in our study participants. Patients who underwent awake craniotomy had statistically significantly lower KORNAFSKY score, lesser days of post-operative admission days and lesser neurological deficits (p-value <0.005) as compared to those who underwent craniotomy under general anesthesia.

Conclusion: Awake craniotomy emerged as superior option as compared to craniotomy under general anesthesia in terms of early post-operative parameters. Lower KORNAFSKY score, lesser days of post-operative admission days and lesser neurological deficits were seen in patients undergoing awake craniotomy.

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References

Sood J, Bhatia P, Johnson JE, Lalwani J, Sethi N. Career as a general speciality anaesthesiologist. Indian J Anaesth 2021; 65(1): 6-11.

https://doi.org/10.4103/ija.IJA_1452_20

Jasper AO, Onohwakpor EA, Akhator A. High-risk surgeries, anesthetic challenges, and real benefits of peripheral regional techniques revisited. Niger J Clin Pract 2021; 24(5): 782-785.

https://doi.org/ 10.4103/njcp.njcp_342_19

Ghaly RF, Kushnarev M, Pirvulescu I, Perciuleac Z, Candido KD, Knezevic NN. A novel checklist for anesthesia in neurosurgical cases. Surg Neurol Int 2021; 12(3): 184.

https://doi.org/10.25259/SNI_285_2021

Voisin MR, Sasikumar S, Mansouri A, Zadeh G. Incidence and prevalence of primary malignant brain tumours in Canada from 1992 to 2017: an epidemiologic study. CMAJ Open 2021; 9(4): E973-E979. https://doi.org/10.9778/cmajo.20200295

Crawford L, Mueller D, Mathews L. Anesthetic Considerations for Functional Neurosurgery. Anesthesiol Clin 2021; 39(1): 227-243. https://doi.org/10.1016/j.anclin.2020.11.013

Fukui A, Muragaki Y, Saito T, Nitta M, Tsuzuki S, Asano H et al. Impact of awake mapping on overall survival and extent of resection in patients with adult diffuse gliomas within or near eloquent areas: a retrospective propensity score-matched analysis of awake craniotomy vs. general anesthesia. Acta Neurochir 2022; 164(2): 395-404.

https://doi.org/10.1007/s00701-021-04999-6

Gupta DK, Chandra PS, Ojha BK, Sharma BS, Mahapatra AK, Mehta VS. Awake craniotomy versus surgery under general anesthesia for resection of intrinsic lesions of eloquent cortex--a prospective randomised study. Clin Neurol Neurosurg 2007; 109(4): 335-343.

https://doi.org/10.1016/j.clineuro.2007.01.008

Gerritsen JKW, Viëtor CL, Rizopoulos D, Schouten JW, Kilmek M, Dirven CMF, et al. Awake craniotomy versus craniotomy under general anesthesia without surgery adjuncts for supratentorial glioblastoma in eloquent areas: a retrospective matched case-control study. Acta Neurochir 2019; 161(2): 307-315.

https://doi.org/10.1007/s00701-018-03788-y

Zhang JJY, Lee KS, Voisin MR, Hervey-Jumper SL, Berger MS, Zadeh G. Awake craniotomy for resection of supratentorial glioblastoma: a systematic review and meta-analysis. Neurooncol Adv 2020; 2(1): vdaa111.

https://doi.org/ 10.1093/noajnl/vdaa111

Khan SA, Nathani KR, Ujjan BU, Barakzai MD, Enam SA, Shafiq F. Awake craniotomy for brain tumours in Pakistan: An initial case series from a developing country. J Pak Med Assoc 2016; 66(Suppl 3)(10): S68-S71.

Ali MZ, Fadel NA, Abouldahab HA. Awake craniotomy versus general anesthesia for managing eloquent cortex low-grade gliomas. Neurosciences 2009; 14(3): 263-272.

Pascual JSG, Omar AT 2nd, Gaddi MJS. Awake Craniotomy in Low-Resource Settings: Findings from a Retrospective Cohort in the Philippines. World Neurosurg. 2021; 145(3): 500-507.e1.

https://doi.org/10.1016/j.wneu.2020.10.070

Fernández-de Thomas RJ, De Jesus O. Craniotomy. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022.

Takami H, Khoshnood N, Bernstein M. Preoperative factors associated with adverse events during awake craniotomy: analysis of 609 consecutive cases. J Neurosurg 2020; 134(5): 1631-1639.

https://doi.org/10.3171/2020.4.JNS20378

Li YC, Chiu HY, Lin YJ, Chen KT, Hsu PW, Huang YC, et al. The Merits of Awake Craniotomy for Glioblastoma in the Left Hemispheric Eloquent Area: One Institution Experience. Clin Neurol Neurosurg. 2021; 200(3): 106343.

https://doi.org/10.1016/j.clineuro.2020.106343

Moiraghi A, Roux A, Peeters S, Pelletier JB, Baroud M, Trancart B, et al. Feasibility, Safety and Impact on Overall Survival of Awake Resection for Newly Diagnosed Supratentorial IDH-Wildtype Glioblastomas in Adults. Cancers 2021; 13(12): 2911.

https://doi.org/10.3390/cancers13122911

Eseonu CI, Rincon-Torroella J, ReFaey K, Lee YM, Nangiana. Awake Craniotomy vs Craniotomy Under General Anesthesia for Perirolandic Gliomas: Evaluating Perioperative Complications and Extent of Resection. Neurosurgery 2017; 81(3): 481-489.

https://doi.org/ 10.1093/neuros/nyx023

Natalini D, Ganau M, Rosenkranz R, Petrinic T, Fitzgibbon K, Antonelli M, et al. Comparison of the Asleep-Awake-Asleep Technique and Monitored Anesthesia Care During Awake Craniotomy: A Systematic Review and Meta-analysis. J Neurosurg Anesthesiol 2022; 34(1): e1-e13.

https://doi.org/10.1097/ANA.0000000000000675