Department of Neurological Surgery, University of Miami Hospital, Miami, FL 33125, USA.
J Neurosurg Anesthesiol. 2013 Jul;25(3):240-7. doi: 10.1097/ANA.0b013e318290c230.
Awake craniotomy (AC) has seen an expanded role in brain tumor surgery over the past few decades. AC allows intraoperative cortical mapping and the continuous assessment of neurophysiological parameters, which are otherwise unattainable under general anesthesia (GA). The ability of AC to analyze eloquent brain areas makes it a powerful method for reducing the risks associated with tumor resection, especially in motor and language cortex. We present a review of the literature to examine the benefits and limits of using AC over GA.
A literature search was performed using the Medline and PubMed databases from 1970 and 2012 that compared craniotomy for tumor resection under GA and AC. Data of interest included length of hospital stay, operating time, extent of resection, and neurological sequelae.
A total of 8 studies with 951 patients (411 utilizing AC and 540 utilizing GA) were included in this review. Our interpretation of the literature suggests that AC (4 d, n=110) results in a shorter hospital stay than GA (9 d, n=116). Mean extent of resection was slightly less under awake conditions (41%, n=321) versus GA (44%, n=444), and postoperative deficits were less frequent under awake conditions (7%, n=411) versus GA (23%, n=520). Surgery time was slightly less in the AC group (165 min, n=324) versus GA (168 min, n=477).
Given the effectiveness of AC for resection of eloquent tumors, the data suggests an expanded role for AC in brain tumor surgery regardless of tumor location.
在过去几十年中，清醒开颅术（AC）在脑肿瘤手术中的作用不断扩大。AC 可实现术中皮质映射和连续评估神经生理参数，而在全身麻醉（GA）下则无法实现这些参数。AC 分析功能区大脑的能力使其成为降低与肿瘤切除相关风险的强大方法，尤其是在运动和语言皮质中。我们回顾了文献，以检查在 GA 与 AC 下进行肿瘤切除术时使用 AC 的益处和局限性。
使用 Medline 和 PubMed 数据库从 1970 年至 2012 年进行文献检索，比较了 GA 和 AC 下进行的肿瘤切除术的开颅术。感兴趣的数据包括住院时间、手术时间、切除范围和神经后遗症。
共有 8 项研究（共 951 例患者，411 例使用 AC，540 例使用 GA）纳入本综述。我们对文献的解释表明，AC（4d，n=110）的住院时间比 GA（9d，n=116）短。在清醒状态下，平均切除范围略小（41%，n=321），而在 GA 下（44%，n=444），术后缺陷在清醒状态下（7%，n=411）较 GA 下（23%，n=520）更为常见。AC 组的手术时间略短（165min，n=324），而 GA 组（168min，n=477）。
鉴于 AC 对语言功能区肿瘤切除的有效性，数据表明，无论肿瘤位置如何，AC 在脑肿瘤手术中的作用都在扩大。
