Comparative analysis of monotherapy versus duotherapy with antiseizure medications for intraoperative and early postoperative seizure control in glioma patients undergoing awake craniotomy.

BACKGROUND

Awake craniotomy (AC) has become the standard technique for eloquent region tumor resection. However, concerns remain regarding perioperative seizure and other complications requiring conversion to general anesthesia or operation termination. To prevent such events, antiseizure medications (ASMs) are commonly used but the effectiveness of their combinations is still debated.

MATERIAL AND METHOD

This study is a retrospective cohort study of patients who underwent awake craniotomy for glioma resection. Patients were divided into two groups based on their seizure control medication: Group S (N = 29) received one ASM, while Group D (N = 26) received dual ASM. We conducted a comparative analysis of intraoperative seizure (IOS) and postoperative seizure (POS) rates between the two groups. Additionally, we evaluated the risk factors associated with POS and the 1-month postoperative Karnofsky Performance Scale (1 M-KPS).

RESULT

A total of 55 patients (41.8% female) with a median age of 39.0 (interquartile range [IQR] 33.0-51.0) were included. The rate of IOS was 27.6% in Group S and 11.5% in Group D, with no statistically significant difference (p = 0.14). POS occurred in 24.1% of group S and 7.7% of group D (p = 0.10), demonstrating comparable rates. Moreover, the length of hospital stay (p = 0.61), the length of ICU stay (p = 0.14), postoperative KPS (p = 0.13), and 1 M-KPS (p = 0.22) were comparable between the two cohorts. The occurrence of POS was not associated with adjuvant therapy or the Isocitrate Dehydrogenase 1 (IDH1) mutation. Univariate and multivariate regression models found preoperative KPS and the extent of resection to have a significant association with 1 M-KPS.

CONCLUSION

Adding a second ASM does not have a significant effect on preventing POS and IOS or improving 1 M-KPS. Accordingly, we recommend against the routine use of dual ASM due to their potential for increased adverse events.