Comparison of Motor Outcome in Patients Undergoing Awake vs General Anesthesia Surgery for Brain Tumors Located Within or Adjacent to the Motor Pathways
Comparison of Motor Outcome in Patients Undergoing Awake vs General Anesthesia Surgery for Brain Tumors Located Within or Adjacent to the Motor Pathways
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DOI：
10.1093/neuros/nyz007
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发表时间：
2019-09-01
期刊：
影响因子：
4.8
通讯作者：
Grossman, Rachel
中科院分区：
文献类型：
--
作者：
Zelitzki, Roni;Korn, Akiva;Grossman, Rachel
背景：轴内脑肿瘤手术切除的目的是在保留功能的同时最大限度地切除肿瘤。清醒开颅术比全麻开颅术在运动保存方面的潜在益处尚不清楚。目的比较在清醒状态和GA状态下行肝周肿瘤手术患者的临床结果。方法2004年至2015年，在同一医院接受新诊断的轴内肿瘤手术切除的1126例患者。回顾性分析了85例患者（44例清醒，41例GA）的完整数据集，这些患者接受了环周肿瘤切除术。结果麻醉患者对运动皮层的识别需要更高的刺激阈值（清醒患者为9.1 4 mA vs 6.2 +/- 2.7 mA, P = 0.0008）。用于评估病变与皮质脊髓束（锥体束）的接近程度的运动反应的皮质下阈值没有组间差异。高级别胶质瘤是最常见的治疗病理。两组间肿瘤切除程度及残余体积无差异。术后运动障碍在麻醉患者1周时更为常见（P = 0.046），但在3个月时两组间无差异。GA组患者的平均住院时间更长（10.3 d比清醒组6.7 d, P = 0.003）。结论与GA下相同手术的患者相比，清醒开颅术后早期运动预后更好，住院时间更短。在被麻醉的患者中，识别运动皮层的皮质阈值较高，这可能表明麻醉剂对运动功能有抑制作用。
BACKGROUND Surgical removal of intra-axial brain tumors aims at maximal tumor resection while preserving function. The potential benefit of awake craniotomy over craniotomy under general anesthesia (GA) for motor preservation is yet unknown.OBJECTIVE To compare the clinical outcomes of patients who underwent surgery for perirolandic tumors while either awake or under GA.METHODS Between 2004 and 2015, 1126 patients underwent surgical resection of newly diagnosed intra-axial tumors in a single institution. Data from 85 patients (44 awake, 41 GA) with full dataset who underwent resections for perirolandic tumors were retrospectively analyzed.RESULTS Identification of the motor cortex required significantly higher stimulation thresholds in anesthetized patients (9.1 4 vs 6.2 +/- 2.7 mA for awake patients, P = .0008). There was no group difference in the subcortical threshold for motor response used to assess the proximity of the lesion to the corticospinal (pyramidal) tract. High-grade gliomas were the most commonly treated pathology. The extent of resection and residual tumor volume were not different between groups. Postoperative motor deficits were more common in the anesthetized patients at 1 wk (P = .046), but no difference between the groups was detected at 3 mo. Patients in the GA group had a longer mean length of hospitalization (10.3 vs 6.7 d for the awake group, P = .003).CONCLUSION Awake craniotomy results in a better early postoperative motor outcome and shorter hospitalization compared with patients who underwent the same surgery under GA. The finding of higher cortical thresholds for the identification of the motor cortex in anesthetized patients may suggest an inhibitory effect of anesthetic agents on motor function.