Awake craniotomy for tumour resection: The safety and feasibility of a simple technique

Abstract

Introduction: Awake craniotomy is widely used for surgery in eloquent brain in order to facilitate maximal safe resection of brain tumours. There has been huge progress in both surgical and anaesthetic techniques used during awake craniotomy. This study reports a single surgeon experience of awake craniotomy for tumour resection over a 14 year period focusing on the safety and feasibility of a simple technique. Methods: Patients who underwent awake craniotomy for tumour resection between 2006 and 2019 (inclusive) were identified retrospectively from theatre logbooks in an NHS neurosciences centre. Case note review was performed to collect data on demographics, histology, intra-operative mapping and complications. Results: Four hundred and sixty-nine patients were included with a mean age of 52.0 ± 14.3 years. Three hundred and seventy-seven (80.2%) of the tumours were primary tumours of which WHO grade IV were the most common (n = 204, 54.1%). Ninety-two (19.6%) of the tumours were metastases with breast (n = 23, 25.0%), skin (n = 22, 23.91%) and lung (n = 22, 23.9%) being the most common primary malignancies. The frontal lobe was the most common location (n = 221, 47.1%). The median length of stay was 1 day. One hundred and seven (22.8%) patients had complications with neurological deficits (n = 73, 15.6%), being the most common however only 8 patients (1.7%) had permanent neurological deficits. Discussion: This is the largest published UK series of awake craniotomy for tumour resection. It demonstrates the safety and feasibility of a simple and easily reproducible technique with a low incidence of permanent neurological deficits and short durations of hospital admission.

Keywords

• Brain tumour
• Awake surgery
• Awake craniotomy
• Glioma