Awake craniotomy for brain tumor resection in the elderly: an institutional experience

Area of Science:

• Neurosurgery
• Geriatric Medicine
• Oncology

Background:

• Awake craniotomy (AC) is crucial for resecting brain tumors near critical areas.
• AC presents unique challenges, particularly for geriatric patients.
• Optimizing peri-operative outcomes in elderly patients undergoing AC is essential.

Purpose of the Study:

• To demonstrate the safety and feasibility of AC in patients over 75 years old.
• To identify peri-operative predictors of post-operative outcomes in this cohort.
• To analyze factors influencing length of stay, readmissions, and discharge disposition.

Main Methods:

• Retrospective review of 70 patients aged 75+ undergoing AC over a decade.
• Multivariate regression analyses to identify predictors of outcomes.
• Key variables included Karnofsky Performance Status (KPS), ASA score, modified Frailty Index (mFI-11), and age.

Main Results:

• High success rate with only 1 conversion to general anesthesia and 4.3% post-operative complications.
• Higher pre-operative KPS correlated with shorter hospitalizations (p=0.011).
• mFI-11 predicted all-cause 30-day readmission (OR 2.38, p=0.007); younger age predicted fewer neurosurgery-specific readmissions (OR 0.59, p=0.010).

Conclusions:

• AC is a feasible and necessary neurosurgical option for the geriatric population.
• Lower frailty, not just younger age, is linked to shorter hospital stays and reduced readmissions.
• Careful patient selection and organized centers contribute to high surgical success in elderly patients undergoing AC.