Eseonu Chikezie I, Rincon-Torroella Jordina, ReFaey Karim, Lee Young M, Nangiana Jasvinder, Vivas-Buitrago Tito, Quiñones-Hinojosa Alfredo
Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, Maryland.
Neurosurgery. 2017 Sep 1;81(3):481-489. doi: 10.1093/neuros/nyx023.
A craniotomy with direct cortical/subcortical stimulation either awake or under general anesthesia (GA) present 2 approaches for removing eloquent region tumors. With a reported higher prevalence of intraoperative seizures occurring during awake resections of perirolandic lesions, oftentimes, surgery under GA is chosen for these lesions.
To evaluate a single-surgeon's experience with awake craniotomies (AC) vs surgery under GA for resecting perirolandic, eloquent, motor-region gliomas.
Between 2005 and 2015, a retrospective analysis of 27 patients with perirolandic, eloquent, motor-area gliomas that underwent an AC were case-control matched with 31 patients who underwent surgery under GA for gliomas in the same location. All patients underwent direct brain stimulation with neuromonitoring and perioperative risk factors, extent of resection, complications, and discharge status were assessed.
The postoperative Karnofsky Performance Score (KPS) was significantly lower for the GA patients at 81.1 compared to the AC patients at 93.3 ( P = .040). The extent of resection for GA patients was 79.6% while the AC patients had an 86.3% resection ( P = .136). There were significantly more 100% total resections in the AC patients 25.9% compared to the GA group (6.5%; P = .041). Patients in the GA group had a longer mean length of hospitalization of 7.9 days compared to the AC group at 4.2 days ( P = .049).
We show that AC can be performed with more frequent total resections, better postoperative KPS, shorter hospitalizations, as well as similar perioperative complication rates compared to surgery under GA for perirolandic, eloquent motor-region glioma.
开颅手术中，在清醒或全身麻醉（GA）状态下进行直接皮质/皮质下刺激是切除功能区肿瘤的两种方法。据报道，在清醒状态下切除中央旁小叶周围病变时，术中癫痫发作的发生率较高，因此，对于这些病变，通常选择在全身麻醉下进行手术。
评估单术者采用清醒开颅手术（AC）与全身麻醉下手术切除中央旁小叶周围、功能区、运动区胶质瘤的经验。
2005年至2015年期间，对27例接受AC的中央旁小叶周围、功能区、运动区胶质瘤患者进行回顾性分析，并与31例在相同部位接受全身麻醉下胶质瘤手术的患者进行病例对照匹配。所有患者均接受直接脑刺激及神经监测，并评估围手术期危险因素、切除范围、并发症及出院状态。
GA组患者术后卡氏功能状态评分（KPS）显著低于AC组，分别为81.1和93.3（P = 0.040）。GA组患者的切除范围为79.6%，而AC组患者的切除范围为86.3%（P = 0.136）。AC组患者的全切率显著高于GA组，分别为25.9%和6.5%（P = 0.041）。GA组患者的平均住院时间为7.9天，长于AC组的4.2天（P = 0.049）。
我们发现，与全身麻醉下手术相比，AC用于切除中央旁小叶周围、功能区、运动区胶质瘤时，全切率更高，术后KPS更好，住院时间更短，围手术期并发症发生率相似。
