Failed awake craniotomy: a retrospective analysis in 424 patients undergoing craniotomy for brain tumor
Failed awake craniotomy: a retrospective analysis in 424 patients undergoing craniotomy for brain tumor
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DOI：
10.3171/2012.10.jns12511
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发表时间：
2013-02-01
影响因子：
4.1
通讯作者：
Ram, Zvi
中科院分区：
文献类型：
--
作者：
Nossek, Erez;Matot, Idit;Ram, Zvi
对象。清醒开颅术是一种成熟的手术方法，用于切除脑内或邻近的轴内肿瘤。然而，清醒开颅失败并没有很好地描述。在本研究中，作者旨在分析和评估清醒开颅失败的发生率和原因。回顾了2003年至2010年在特拉维夫医学中心进行的清醒开颅手术数据库。如果需要转换为全身麻醉，或者不能实现充分的绘图或监测，则清醒开颅术被认为是失败的。在接受清醒开颅术的488例患者中，424例被确认有完整的医疗、手术和麻醉记录。在424例患者中，27例（6.4%）的清醒开颅手术失败。失败的主要原因是术中缺乏与患者的沟通（n = 18[4.2%]）和/或术中癫痫发作（n = 9[2.1%]）。术前混合性吞咽障碍（p < 0.001）和苯妥英治疗（p = 0.0019）与缺乏沟通有关。癫痫发作史（p = 0.03）和多种抗癫痫药物治疗（p = 0.0012）与术中癫痫发作失败有关。与清醒开颅成功组相比，总全切除率明显降低（83% vs 54%, p = 0.008），术后短期言语恶化发生率（6.1% vs 23.5%, p = 0.0017）及术后3个月发生率（2.3% vs 15.4%, p = 0.0002）较高，住院时间较长（4.9 +/- 6.2天vs 8.0 +/- 10.1天，p < 0.001）。失败组（27例中有4例[14.8%]）的主要并发症发生率明显高于成功组（397例中有16例[4%]）（p = 0.037）。清醒开颅手术的失败与较低的总切除发生率和较高的术后发病率相关。大多数清醒开颅手术失败是可以通过适当的患者选择和避免手术中使用药物的副作用来预防的。(http://thejns.org/doi/abs/10.3171/2012.10.JNS12511)
Object. Awake craniotomy for removal of intraaxial tumors within or adjacent to eloquent brain regions is a well-established procedure. However, awake craniotomy failures have not been well characterized. In the present study, the authors aimed to analyze and assess the incidence and causes for failed awake craniotomy.Methods. The database of awake craniotomies performed at Tel Aviv Medical Center between 2003 and 2010 was reviewed. Awake craniotomy was considered a failure if conversion to general anesthesia was required, or if adequate mapping or monitoring could not have been achieved.Results. Of 488 patients undergoing awake craniotomy, 424 were identified as having complete medical, operative, and anesthesiology records. The awake craniotomies performed in 27 (6.4%) of these 424 patients were considered failures. The main causes of failure were lack of intraoperative communication with the patient (n = 18 [4.2%]) and/or intraoperative seizures (n = 9 [2.1%]). Preoperative mixed dysphasia (p < 0.001) and treatment with phenytoin (p = 0.0019) were related to failure due to lack of communication. History of seizures (p = 0.03) and treatment with multiple antiepileptic drugs (p = 0.0012) were found to be related to failure due to intraoperative seizures. Compared with the successful awake craniotomy group, a significantly lower rate of gross-total resection was achieved (83% vs 54%, p = 0.008), there was a higher incidence of short-term speech deterioration postoperatively (6.1% vs 23.5%, p = 0.0017) as well as at 3 months postoperatively (2.3% vs 15.4%, p = 0.0002), and the hospitalization period was longer (4.9 +/- 6.2 days vs 8.0 +/- 10.1 days, p < 0.001). Significantly more major complications occurred in the failure group (4 [14.8%] of 27) than in the successful group (16 [4%] of 397) (p = 0.037).Conclusions. Failures of awake craniotomy were associated with a lower incidence of gross-total resection and increased postoperative morbidity. The majority of awake craniotomy failures were preventable by adequate patient selection and avoiding side effects of drugs administered during surgery. (http://thejns.org/doi/abs/10.3171/2012.10.JNS12511)