Awake craniotomy vs surgery under general anesthesia for resection of supratentorial lesions

The use of an awake craniotomy in the treatment of supratentorial lesions is a challenge for both patients and staff in the operation theater.

To assess the safety and effectiveness of an awake craniotomy with brain mapping in comparison with a craniotomy performed under general anesthesia.

We prospectively compared 2 groups of patients who underwent surgery for supratentorial lesions: those in whom an awake craniotomy with intraoperative brain mapping was used (AC group, n = 214) and those in whom surgery was performed under general anesthesia (GA group, n = 361, including 72 patients with lesions in eloquent areas). The AC group included lesions in close proximity to the eloquent cortex that were surgically treated on an elective basis.

Globally, the 2 groups were comparable in terms of sex, age, American Society of Anesthesiologists score, pathology, size of lesions, quality of resection, duration of surgery, and neurological outcome, and different in tumor location and preoperative neurological deficits (higher in the AC group). However, specific data analysis of patients with lesions in eloquent areas revealed a significantly better neurological outcome and quality of resection (P < .001) in the AC group than the subgroup of GA patients with lesions in eloquent areas. Surgery was uneventful in AC patients and they were discharged home sooner.

AC with brain mapping is safe and allows maximal removal of lesions close to functional areas with low neurological complication rates. It provides an excellent alternative to craniotomy under GA.