Honeyman Susan I, Boukas Alexandros, Akhbari Melika, Okoli Blessing, Stacey Richard, Apostolopoulos Vasileios, Plaha Puneet
Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Nuffield Department of Surgery, University of Oxford, Oxford, UK.
Neurosurg Rev. 2025 Sep 1;48(1):628. doi: 10.1007/s10143-025-03787-5.
Awake craniotomy (AC) can aid in preserving neurological function through intraoperative mapping of sensorimotor and language functions. It has been associated with increased extent of resection (EOR) and reduced neurological deficits in glioma patients. Most studies focused on low grade tumours and there remains limited evidence assessing utility of AC for glioblastoma (GB). This systematic review evaluates current evidence for safety and efficacy of GB resection under AC versus general anaesthetic (GA) conditions. We carried out a systematic review and meta-analysis of original studies assessing comparative outcomes of supratentorial GB resection via AC versus GA. Studies included patients > 18 years of age, with histopathological diagnosis of Grade 4 GB affecting an eloquent location. Medline, Embase and Pubmed were searched from inception to the 30th of June 2025. The outcomes assessed included: EOR, rates of temporary and permanent post-operative neurological deficits, survival, and functional outcomes. Eleven studies were included, with 1355 patients (402 AC and 953 GA resections). AC achieved greater percentage EOR (MD = 7.55 [CI 2.94-12.15], p = 0.001), and non-significant increase in rates of gross total resection (OR = 1.66 [CI 0.64-4.35], p = 0.30). The risk of developing a post-operative neurological deficit was significantly lower with AC (OR = 0.55 [CI:0.36-0.85], p = 0.008). Overall survival (HR = 7.99 [CI 2.29-13.69], p = 0.007) was significantly increased with AC but there was no significant difference in progression-free survival (HR = 2.03 [CI -1.32-5.37], p = 0.23). AC for eloquently located GB is associated with improved EOR, survival and lower risk of neurological complications. When feasible, AC should be considered for eloquent GB resection.
清醒开颅手术（AC）可通过术中对感觉运动和语言功能进行定位来帮助保留神经功能。它与胶质瘤患者切除范围（EOR）的增加和神经功能缺损的减少有关。大多数研究集中于低级别肿瘤，而评估AC用于胶质母细胞瘤（GB）的效用的证据仍然有限。本系统评价评估了在AC与全身麻醉（GA）条件下GB切除的安全性和有效性的现有证据。我们对评估经AC与GA进行幕上GB切除的比较结果的原始研究进行了系统评价和荟萃分析。研究纳入年龄大于18岁、经组织病理学诊断为4级GB且病变位于功能区的患者。检索了Medline、Embase和Pubmed数据库，检索时间从建库至2025年6月30日。评估的结果包括：EOR、术后临时和永久性神经功能缺损发生率、生存率和功能结局。纳入了11项研究，共1355例患者（402例行AC切除，953例行GA切除）。AC实现了更高百分比的EOR（MD = 7.55 [CI 2.94 - 12.15]，p = 0.001），全切除率有非显著性增加（OR = 1.66 [CI 0.64 - 4.35]，p = 0.30）。AC术后发生神经功能缺损的风险显著更低（OR = 0.55 [CI:0.36 - 0.85]，p = 0.008）。AC显著提高了总生存率（HR = 7.99 [CI 2.29 - 13.69]，p = 0.007），但无进展生存期无显著差异（HR = 2.03 [CI -1.32 - 5.37]，p = 0.23）。对于病变位于功能区的GB，AC与更高的EOR、生存率及更低的神经并发症风险相关。在可行的情况下，对于病变位于功能区的GB切除应考虑采用AC。
