Intra- and postoperative adverse events in awake craniotomy for intrinsic supratentorial brain tumors

• Published in: Neurological sciences Vol. 42; no. 4; pp. 1437 - 1441
• Main Authors: Kwinta, Borys M., Myszka, Aneta M., Bigaj, Monika M., Krzyżewski, Roger M., Starowicz-Filip, Anna
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.04.2021; Springer Nature B.V
• Subjects: Antiepileptic agents; Brain cancer; Brain Mapping; Brain Neoplasms - surgery; Brain tumors; Cardiac arrhythmia; Convulsions & seizures; Craniotomy - adverse effects; Drug therapy; Glioma - surgery; Humans; Hypertension; Language; Medicine; Medicine & Public Health; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Original; Original Article; Pain; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Psychiatry; Seizures; Seizures - epidemiology; Seizures - etiology; Surgery; Tachycardia; Wakefulness; Hypertension; Intrinsic brain tumor; Awake craniotomy; Adverse events; Complications; Seizures
• ISSN: 1590-1874; 1590-3478
• DOI: 10.1007/s10072-020-04683-0

Objective To determine the frequency and consequences of intra- and postoperative adverse events in awake craniotomy for intrinsic supratentorial brain tumors. Despite the growing prevalence of awake craniotomy intra- and postoperative, adverse events related to this surgery are poorly discussed. Methods We studied 25 patients undergoing awake craniotomy with maximum safe resection of intrinsic supratentorial brain tumors in the awake-asleep-awake protocol. Results Surgery-related inconveniences occurred in 23 patients (92%), while postoperative adverse events were observed in 17 cases (68%). Seven patients suffered from more than one postoperative complication. The most common surgery-related inconvenience was intraoperative hypertension (8 cases, 32%), followed by discomfort (7 cases, 28%), pain during surgery (5 cases, 20%), and tachycardia (3 cases, 12%). The most common postoperative adverse event was a new language deficit that occurred in 10 cases (40%) and remained permanent in one case (4%). Motor deficits occurred in 36% of cases and were permanent in one case (1%). Seizures were observed in 4 cases (16%) intra- and in 2 cases (8%) postoperatively. Seizures appeared more frequently in patients with multilobar insular-involving gliomas and in patients without prophylactic antiepileptic drug therapy. Conclusions Surgery-related inconveniences and postoperative adverse events occur in most awake craniotomies. The most common intraoperative adverse event is hypertension, pain, and tachycardia. The most frequent postoperative adverse events are new language deficits and new motor deficits.