Lu Victor M, Phan Kevin, Rovin Richard A
Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
Clin Neurol Neurosurg. 2018 Jun;169:121-127. doi: 10.1016/j.clineuro.2018.04.011. Epub 2018 Apr 9.
Surgical resection of eloquent glioma can be achieved under general anesthesia (GA) or awake anesthesia (AA). The appeal of AA is that it facilitates intraoperative identification and avoidance of eloquent areas, which has the potential to minimize functional compromise. The aim of this meta-analysis was to compare the operative outcomes of eloquent glioma resection performed under GA compared to AA to assist in optimizing the decision algorithm between the two approaches. Searches of seven electronic databases from inception to December 2017 were conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. There were 1037 articles identified for screening. Data were extracted and analyzed using meta-analysis of proportions. A total of 9 comparative studies were included for analysis. Resection of glioma involving eloquent areas achieved under AA is mostly comparable in terms of operative and functional outcomes to that of GA. AA did demonstrate significantly lower incidence of postoperative nausea and vomiting (PONV, OR, 0.17; p < 0.001) and shorter length of stay (LOS, MD, -1.76 days; p = 0.02) when compared to GA. Future studies that are larger, prospective, randomized, and include long term quality of life metrics will assist in elucidating the true clinical benefit of AA in resecting glioma involving eloquent areas. This will assist in further developing management protocol of these glioma.
功能区胶质瘤的手术切除可在全身麻醉（GA）或清醒麻醉（AA）下进行。清醒麻醉的吸引力在于它有助于术中识别和避开功能区，这有可能将功能损害降至最低。本荟萃分析的目的是比较在全身麻醉与清醒麻醉下进行功能区胶质瘤切除的手术结果，以帮助优化这两种方法之间的决策算法。按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，对从数据库建立至2017年12月的七个电子数据库进行了检索。共识别出1037篇文章以供筛选。使用比例的荟萃分析提取和分析数据。总共纳入9项比较研究进行分析。在手术和功能结果方面，清醒麻醉下进行的涉及功能区的胶质瘤切除大多与全身麻醉下的切除相当。与全身麻醉相比，清醒麻醉确实显示出术后恶心和呕吐的发生率显著降低（PONV，OR，0.17；p<0.001），住院时间缩短（LOS，MD，-1.76天；p=0.02）。未来规模更大、前瞻性、随机且包括长期生活质量指标的研究将有助于阐明清醒麻醉在切除涉及功能区的胶质瘤方面的真正临床益处。这将有助于进一步制定这些胶质瘤的管理方案。
