Document Detail


Outcome of fully awake craniotomy for lesions near the eloquent cortex: analysis of a prospective surgical series of 79 supratentorial primary brain tumors with long follow-up.
MedLine Citation:
PMID:  19730779     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Despite possible advantages, few surgical series report specifically on awake craniotomy for intrinsic brain tumors in eloquent brain areas. OBJECTIVES: Primary: To evaluate the safety and efficacy of fully awake craniotomy (FAC) for the resection of primary supratentorial brain tumors (PSBT) near or in eloquent brain areas (EBA) in a developing country. Secondary: To evaluate the impact of previous surgical history and different treatment modalities on outcome. PATIENTS AND METHODS: From 1998 to 2007, 79 consecutive FACs for resection PSBT near or in EBA, performed by a single surgeon, were prospectively followed. Two groups were defined based on time period and surgical team: group A operated on from March 1998 to July 2004 without a multidisciplinary team and group B operated on from August 2004 to October 2007 in a multidisciplinary setting. For both time periods, two groups were defined: group I had no previous history of craniotomy, while group II had undergone a previous craniotomy for a PSBT. Forty-six patients were operated on in group A, 46 in group B, 49 in group I and 30 in group II. Psychological assessment and selection were obligatory. The preferred anesthetic procedure was an intravenous high-dose opioid infusion (Fentanil 50 microg, bolus infusion until a minimum dose of 10 microg/kg). Generous scalp and periosteous infiltrations were performed. Functional cortical mapping was performed in every case. Continuous somato-sensory evoked potentials (SSEPs) and phase reversal localization were available in 48 cases. Standard microsurgical techniques were performed and monitored by continuous clinical evaluation. RESULTS: Clinical data showed differences in time since clinical onset (p < 0.001), slowness of thought (p = 0.02) and memory deficits (p < 0.001) between study periods and also time since recent seizure onset for groups I and II (p = 0.001). Mean tumor volume was 51.2 +/- 48.7 cm3 and was not different among the four groups. The mean extent of tumor reduction was 90.0 +/- 12.7% and was similar for the whole series. A trend toward a larger incidence of glioblastoma multiforme occurred in group B (p = 0.05) and I (p = 0.04). Recovery of previous motor deficits was observed in 75.0% of patients, while motor worsening in 8.9% of cases. Recovery of semantic language deficits, control of refractory seizures and motor worsening were statistically more frequent in group B (p = 0.01). Satisfaction with the procedure was reported by 89.9% of patients, which was similar for all groups. Clinical complications were minimal, and surgical mortality was 1.3%. CONCLUSIONS: These data suggest that FAC is safe and effective for the resection of PSBT in EBA as the main technique, and in a multidisciplinary context is associated with greater clinical and physiological monitoring. The previous history of craniotomy for PSBT did not seem to influence the outcome.
Authors:
Luiz Claudio Modesto Pereira; Karina M Oliveira; Gisele L L'Abbate; Ricardo Sugai; Joines A Ferreira; Luiz A da Motta
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Acta neurochirurgica     Volume:  151     ISSN:  0942-0940     ISO Abbreviation:  Acta Neurochir (Wien)     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-10-15     Completed Date:  2010-01-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0151000     Medline TA:  Acta Neurochir (Wien)     Country:  Austria    
Other Details:
Languages:  eng     Pagination:  1215-30     Citation Subset:  IM    
Affiliation:
Hospital de Base do Distrito Federal, Brasilia, Brazil. luizpereira@ambr.com.br
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Analgesics, Opioid / therapeutic use
Brain Mapping / methods
Brain Neoplasms / pathology,  physiopathology,  surgery*
Cerebral Cortex / pathology,  radiography,  surgery*
Cognition Disorders / etiology,  physiopathology,  surgery
Cohort Studies
Craniotomy / methods*,  mortality,  statistics & numerical data
Evoked Potentials, Somatosensory / physiology
Female
Fentanyl / therapeutic use
Follow-Up Studies
Humans
Intraoperative Period*
Male
Middle Aged
Monitoring, Intraoperative / methods*,  mortality,  statistics & numerical data
Neoplasm Invasiveness
Neoplasm Recurrence, Local / epidemiology,  surgery
Outcome Assessment (Health Care) / methods*
Paresis / etiology,  physiopathology,  surgery
Prospective Studies
Recovery of Function / physiology
Time
Treatment Outcome
Young Adult
Chemical
Reg. No./Substance:
0/Analgesics, Opioid; 437-38-7/Fentanyl

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