Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, 200040, China.
Institute of Neurosurgery, Fudan University, Shanghai, 200040, China.
Neurosurg Rev. 2021 Aug;44(4):1997-2011. doi: 10.1007/s10143-020-01418-9. Epub 2020 Oct 21.
Awake craniotomy with language mapping is being increasingly applied to avoid postoperative language dysfunctions worldwide. However, the effectiveness and reliability of this technique remain unclear due to the paucity of studies comparing the awake craniotomy with general anesthesia. To determine the benefit of awake craniotomy for language, motor, and neurological functions, as well as other clinical outcomes, we searched Medline, Embase, the Cochrane Library, and the Chinese Biomedical Literature Database up to December 2019. Gray literatures were also searched. We included randomized and non-randomized controlled studies comparing awake craniotomy versus general anesthetic resection and reporting the language and neurological outcomes. Ten studies with 833 patients were included in the meta-analysis. The pooled risk ratio (RR) suggested no significant differences in language and neurological outcomes between general anesthesia group and awake craniotomy group without electrical stimulation. Awake craniotomy with electrical stimulation, however, was associated with improved late language and neurological outcomes (≥ 3 months) versus general anesthesia with pooled RR of 0.44 (95% CI = 0.20-0.96) and 0.49 (95% CI = 0.30-0.79), respectively. Awake craniotomy with electrical stimulation was also associated with better extent of resection with the pooled RR of 0.81 (95%CI = 0.71-0.92) and shorter hospital stay duration with the pooled weighted mean difference (WMD) of - 1.14 (95%CI = - 1.80 to - 0.48). This meta-analysis suggested that the application of awake craniotomy with electrical stimulation during glioma resection is associated with lower risks of long-term neurological and language deficits and higher extent of tumor resection, as well as shorter hospital stay duration.
唤醒开颅术联合语言定位术在全球范围内被越来越多地应用于避免术后语言功能障碍。然而，由于缺乏比较唤醒开颅术与全身麻醉的研究，该技术的有效性和可靠性仍不清楚。为了确定唤醒开颅术在语言、运动和神经功能以及其他临床结果方面的益处，我们检索了 Medline、Embase、Cochrane 图书馆和中国生物医学文献数据库，检索截至 2019 年 12 月。也检索了灰色文献。我们纳入了比较唤醒开颅术与全身麻醉切除术并报告语言和神经结果的随机和非随机对照研究。Meta 分析纳入了 10 项研究共 833 例患者。汇总的风险比（RR）表明，在没有电刺激的情况下，全身麻醉组和唤醒开颅组的语言和神经结局没有显著差异。然而，与全身麻醉相比，唤醒开颅术联合电刺激在≥3 个月时可改善语言和神经结局，汇总 RR 分别为 0.44（95%CI=0.20-0.96）和 0.49（95%CI=0.30-0.79）。唤醒开颅术联合电刺激还与更好的切除程度相关，汇总 RR 为 0.81（95%CI=0.71-0.92），与较短的住院时间相关，汇总加权均数差（WMD）为-1.14（95%CI=-1.80 至-0.48）。这项荟萃分析表明，在脑胶质瘤切除术中应用唤醒开颅术联合电刺激与降低长期神经和语言缺陷的风险以及提高肿瘤切除程度以及缩短住院时间相关。
