Abstract Date: 4/8/2014
Shawn Level Hervey-Jumper, MD
Mitchel Berger, MD
Darryl Lau, MD (San Francisco, CA)
Awake craniotomy is an established procedure for testing and identification of functional areas. Identification of these locations allows for more aggressive extent of brain tumor resection and therefore improved survival. The goal of this study was to examine the way in which these surgeries were performed including methods and optimal techniques.
We retrospectively studied 561 patients undergoing awake brain tumor surgery by a single author (M.B.) for tumors in functional regions between 1997-2013.
The median patient age was 42. 75% percent of patients had KPS 90-100 and 25% KPS <80. Fifty-four percent of patients received surgery for high-grade gliomas, 43% low-grade gliomas, 1% metastatic lesions, and 2% other (cortical dysplasia, etc). The majority of patients were ASA class 1 or 2 (mild systemic disease) however patients with severe systemic disease were not excluded representing 29% of study participants. Preoperative airway analysis revealed complete visualization of soft palate and uvula in 79% of patients (mallampati score 1-2). Laryngeal mask airway (LMA) was used in 7 patients (1.2%), most commonly used in large vascular tumors with mass effect. Mannitol was given in 68% of cases and used more commonly in high-grade tumors (p=0.03). Sixteen percent of patients were active smokers, which did not impact mapping or length of stay. Intraoperative seizures occurred in 3% of patients. Preoperative seizure history and number of preoperative antiepileptic drugs had no effect on the frequency or control of intraoperative stimulation induced seizures. Mapping was aborted in 3 cases (0.5%) due to intraoperative seizures (2 cases) and patient emotional intolerance (1 case).
These findings suggest that awake brain tumor surgery can be safely performed with an extremely low failure rate regardless of ASA classification, Mallampati score, BMI, smoking status, psychiatric, seizure history, vascularity, or tumor mass effect.
Article ID: AA-28772