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Lateral Chronic Cranial Window Preparation Enables In Vivo Observation Following Distal Middle Cerebral Artery Occlusion in Mice

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Frailty is Not Associated With Awake Craniotomy Outcome: A Single Institution Experience.

Adeline L Fecker¹, Matthew K McIntyre¹, Molly Joyce¹

¹Department of Neurological Surgery, Oregon Health & Science University, Portland , Oregon , USA.

Operative Neurosurgery (Hagerstown, Md.)

|April 8, 2025

Summary

Patient frailty, measured by the Modified Frailty Index-11 (mFI-11), is linked to longer hospital stays and higher anesthetic risk in awake craniotomy patients. However, frailty did not significantly increase the risk of unsuccessful procedures or poor neurological outcomes.

Keywords:

Awake craniotomy Cortical stimulation mapping Failed Failure Frailty Glioma Outcomes

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Published on: July 26, 2024

Area of Science:

Neurosurgery
Anesthesiology
Geriatric Medicine

Background:

Patient frailty is a key predictor of surgical outcomes.
Effective patient selection is crucial for awake craniotomy success, impacting intraoperative mapping and anesthesia conversion.
Understanding frailty's role can optimize patient selection and outcomes in awake craniotomy.

Purpose of the Study:

To evaluate the association between patient frailty and the success of awake craniotomy.
To determine if frailty predicts unsuccessful awake craniotomy or poor postoperative outcomes.

Main Methods:

A retrospective study of 143 adult patients undergoing first-time awake craniotomy (2018-2024).
The Modified Frailty Index-11 (mFI-11) was used to assess frailty (mFI-11 ≥2).
Associations between frailty and awake craniotomy outcomes were analyzed.

Main Results:

39% of patients were identified as frail (mFI-11 ≥2).
Frail patients were older, had higher ASA classification, obstructive sleep apnea, higher BMI, and glioblastoma.
Frail patients experienced longer hospital stays and increased likelihood of discharge to skilled nursing or rehab facilities.

Conclusions:

Frailty is associated with increased anesthetic risk and longer length of stay in awake craniotomy.
Frailty was not significantly linked to conversion to general anesthesia, incomplete mapping, or neurological deficits.
Frailty assessment may inform anesthetic risk stratification but not necessarily procedural success in awake craniotomy.