Awake craniotomy versus general anesthesia for managing eloquent cortex low-grade gliomas

Area of Science:

• Neurosurgery
• Anesthesiology
• Oncology

Background:

• Low-grade gliomas often infiltrate eloquent brain regions, posing challenges for complete surgical resection.
• Conventional general anesthesia (GA) may limit intraoperative neurological monitoring during glioma excision.
• Awake craniotomy offers a potential alternative for preserving neurological function.

Purpose of the Study:

• To compare the efficacy and safety of awake craniotomy with conscious sedation versus general anesthesia (GA) for low-grade glioma excision.
• To evaluate intraoperative and postoperative outcomes, including neurological function and patient comfort.
• To assess the impact of anesthetic technique on tumor resection extent.

Main Methods:

• A prospective study of 40 patients (ASA I-II, aged 23-55) with low-grade gliomas near eloquent brain areas.
• Group 1 (n=20): General anesthesia with endotracheal intubation. Group 2 (n=20): Awake craniotomy using local anesthesia, propofol, and fentanyl.
• Patients were monitored for neurological deficits, agitation, sedation levels, nausea, and vomiting.

Main Results:

• Awake craniotomy patients showed significantly better immediate postoperative neurological outcomes (90% vs. 40% with no new deficits).
• Postoperative nausea and vomiting were significantly lower in the awake group (p=0.039).
• Gross total tumor resection rates were comparable between groups, though slightly higher in the GA group.

Conclusions:

• Awake craniotomy with conscious sedation is a safe and effective technique for resecting low-grade gliomas in eloquent brain areas.
• This method allows for real-time physiological monitoring, potentially improving neurological preservation.
• Awake craniotomy represents a relatively simple, cost-effective alternative to GA for specific neurosurgical procedures.