Failed awake craniotomy: a retrospective analysis in 424 patients undergoing craniotomy for brain tumor

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.

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Intraoperative Seizures During Awake Craniotomy

Neurosurgery ◽

10.1227/01.neu.0000429847.91707.97 ◽

2013 ◽

Vol 73 (1) ◽

pp. 135-140 ◽

Cited By ~ 73

Author(s):

Erez Nossek ◽

Idit Matot ◽

Tal Shahar ◽

Ori Barzilai ◽

Yoni Rapoport ◽

...

Keyword(s):

Frontal Lobe ◽

Medical Center ◽

Length Of Hospital Stay ◽

Postoperative Outcome ◽

Awake Craniotomy ◽

Short Term ◽

Intractable Seizures ◽

Hospitalization Period ◽

Incidence Risk ◽

History Of

Abstract BACKGROUND: Awake craniotomy (AC) for removal of intra-axial brain tumors is a well-established procedure. However, the occurrence and consequences of intraoperative seizures during AC have not been well characterized. OBJECTIVE: To analyze the incidence, risk factors, and consequences of seizures during AC. METHODS: The database of AC at Tel Aviv Medical Center between 2003 to 2011 was reviewed. Occurrences of intraoperative seizures were analyzed with respect to medical history, medications, tumor characteristics, and postoperative outcome. RESULTS: Of the 549 ACs performed during the index period, 477 with complete records were identified. Sixty patients (12.6%) experienced intraoperative seizures. The AC procedure failed in 11 patients (2.3%) due to seizures. Patients with intraoperative seizures were significantly younger than nonseizing patients (45 ± 14 years vs 52 ± 16 years, P = .003), had a higher incidence of frontal lobe involvement (86% vs % 57%, P < .0001), and had higher prevalence of a history of seizures (P = .008). Short-term motor deterioration developed postoperatively in a higher percentage of patients with intraoperative seizures (20% vs 10.1%, P = .02) with a longer hospitalization period (4.0 ± 3.0 days vs 3.0 ± 3.0 days, P = .045). CONCLUSION: Although in most cases intraoperative seizures will not result in AC failure, the surgical team should be prepared to treat them promptly to avoid intractable seizures. Intraoperative seizures are more common in younger patients with a tumor in the frontal lobe and those with a history of seizures. Moreover, they are associated with a higher incidence of transient postoperative motor deterioration and protracted length of hospital stay.

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Microsurgical Gross Total Resection of a Large Residual/Recurrent Vestibular Schwannoma via Translabyrinthine Approach

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1669971 ◽

2018 ◽

Vol 79 (S 05) ◽

pp. S387-S388

Author(s):

Sima Sayyahmelli ◽

Joseph Roche ◽

Mustafa Baskaya

Keyword(s):

Vestibular Schwannoma ◽

Gross Total Resection ◽

Subtotal Resection ◽

Total Resection ◽

Entry Zone ◽

Stereotactic Radiation ◽

Translabyrinthine Approach ◽

History Of ◽

Microsurgical Techniques ◽

Facial Function

Although, gross total resection in large vestibular schwannomas is an ideal goal, subtotal resection is frequently performed due to lack of expertise, concerns for facial palsy, or overuse of stereotactic radiation. In this video, we present a 31-year-old man with a 7-year history of tinnitus, dizziness, and hearing loss. The patient had a subtotal resection of a 2.5 cm right-sided vestibular schwannoma via retrosigmoid craniotomy at an outside hospital. He was referred for further surgical resection due to the increased size of the tumor on surveillance magnetic resonance imagings (MRIs) and worsening symptoms. MRI showed a residual/recurrent large schwannoma with extension to the full length of the internal acoustic canal and brain stem compression. He underwent microsurgical gross total resection via a translabyrinthine approach. The facial nerve was preserved and stimulated with 0.15 mA at the brainstem entry zone. He awoke with House–Brackmann grade III facial function, with an otherwise uneventful postoperative course. In this video, microsurgical techniques and important resection steps for this residual/recurrent vestibular schwannoma are demonstrated, and nuances for microsurgical technique are discussed.The link to the video can be found at: https://youtu.be/a0ZxE41Tqzw.

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Long-term Seizure Control Outcomes After Resection of Gangliogliomas

Neurosurgery ◽

10.1227/neu.0b013e3182500a4c ◽

2012 ◽

Vol 70 (6) ◽

pp. 1406-1414 ◽

Cited By ~ 55

Author(s):

Derek G. Southwell ◽

Paul A. Garcia ◽

Mitchel S. Berger ◽

Nicholas M. Barbaro ◽

Edward F. Chang

Keyword(s):

Tumor Progression ◽

Seizure Control ◽

Intractable Epilepsy ◽

Gross Total Resection ◽

Subtotal Resection ◽

Seizure Outcome ◽

Seizure Freedom ◽

Total Resection ◽

History Of

Abstract BACKGROUND: Gangliogliomas are rare glioneuronal tumors that typically cause refractory seizures during the first 3 decades of life. OBJECTIVE: To determine the prognosticators of seizure outcome after surgery for ganglioglioma. METHODS: We reviewed the cases of 66 patients who underwent resection of gangliogliomas at the University of California, San Francisco. Demographic, seizure history, and operative data were examined for statistical association with postoperative seizure outcomes. RESULTS: Of the 66 patients who underwent surgical resection of ganglioglioma, 49 patients (74%) presented with a history of seizures. Of those 49 patients, 50% presented with intractable epilepsy. Temporal lobe gangliogliomas were present in 76% of the patients who presented with a history of seizures. Electrocorticography was performed on 35% of the patients, and of those patients, 82% underwent extended lesionectomy to remove abnormally epileptogenic extralesional tissue. The median follow-up duration was 6.9 years, during which tumor progression occurred in 38% of patients who underwent subtotal resection and in 8% of patients who underwent gross total resection (P = .02). Overall, 85% of patients were seizure free (International League Against Epilepsy class I or II) 5 years after surgery. Subtotal resection was associated with poor seizure outcomes 1 year after resection (odds ratio = 14.6; 95% confidence interval = 2.4-87.7): rates of seizure freedom were 54% after subtotal resection, 96% after gross total resection, and 93% after gross total resection with intraoperative electrocorticography-guided extended lesionectomy. CONCLUSION: We report excellent long-term seizure control outcomes after surgery for gangliogliomas. Intraoperative electrocorticography may be a useful adjunct for guiding extended resection in certain pharmacoresistant epilepsy patients with gangliogliomas. Subtotal resection is associated with higher rates of tumor progression and nonoptimal seizure outcomes.

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Dermatofibrosarcoma of the scalp

Surgical Neurology International ◽

10.25259/sni_458_2019 ◽

2019 ◽

Vol 10 ◽

pp. 221 ◽

Cited By ~ 1

Author(s):

Marcos Sangrador ◽

Jimena González Olvera ◽

Valeria Mendoza Ortiz

Keyword(s):

Local Recurrence ◽

Surgical Management ◽

Dermatofibrosarcoma Protuberans ◽

Gross Total Resection ◽

High Grade ◽

Rare Tumor ◽

Parietal Region ◽

Total Resection ◽

History Of ◽

The Right

A 25-year-old woman presented with a 4 months history of progressive pain and tumefaction in the right parietal region. Deformity of the scalp was evident, and a biopsy was taken, reporting a high- grade dermatofibrosarcoma. She underwent surgical management, achieving a gross total resection. Dermatofibrosarcoma protuberans is a rare tumor arising from the dermis. It tends to have an indolent course and local recurrence after excision.

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Intraparenchymal Epidermoid Cyst Close to Broca Area—Awake Craniotomy and Gross Total Resection

World Neurosurgery ◽

10.1016/j.wneu.2020.06.135 ◽

2020 ◽

Vol 141 ◽

pp. 367-372 ◽

Cited By ~ 1

Author(s):

Leonardo J.M. de Macêdo Filho ◽

Gilnard C.M. Aguiar ◽

Fátima C. Pessoa ◽

Gabryella S. Diógenes ◽

Felipe S. Borges ◽

...

Keyword(s):

Epidermoid Cyst ◽

Awake Craniotomy ◽

Gross Total Resection ◽

Total Resection

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Intraventricular astroblastoma

Journal of Neurosurgery Pediatrics ◽

10.3171/ped/2008/1/2/152 ◽

2008 ◽

Vol 1 (2) ◽

pp. 152-155 ◽

Cited By ~ 13

Author(s):

Luca Denaro ◽

Marina Gardiman ◽

Milena Calderone ◽

Marta Rossetto ◽

Pietro Ciccarino ◽

...

Keyword(s):

Adjuvant Therapy ◽

Relevant Literature ◽

Radical Resection ◽

Cystic Mass ◽

Gross Total Resection ◽

Total Resection ◽

Initial Surgery ◽

History Of ◽

Well Differentiated ◽

Brain Gliomas

✓Astroblastoma is a rare primary brain neoplasm that accounts for 0.45–2.8% of brain gliomas. Intraventricular localization is extremely rare. The authors report a case of well-differentiated completely intraventricular astroblastoma in a 6-year-old girl and review the relevant literature. Their patient presented with a 5-week history of progressive nausea and vomiting. Magnetic resonance (MR) imaging revealed a large, well-demarcated, solid-cystic mass in the left temporooccipital ventricular horn. Macroscopic radical resection of the tumor was performed via the superior temporal sulcus. The postoperative course was uneventful and no adjuvant therapy was administered after surgery. No recurrence was detected at 9-months follow-up. Gross-total resection has the greatest impact on patient survival. In differentiated tumors, recurrence is usually local, and adjuvant therapy is recommended after repeated resection for the treatment of recurrence. In patients harboring anaplastic astroblastoma, gross-total resection and adjuvant therapy after the initial surgery seems to be the best choice. It is important to distinguish astroblastoma from ependymoma in clinical practice because of the differences in therapeutic approaches.

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Tumor location and IDH1 mutation may predict intraoperative seizures during awake craniotomy

Journal of Neurosurgery ◽

10.3171/2014.7.jns132657 ◽

2014 ◽

Vol 121 (5) ◽

pp. 1133-1138 ◽

Cited By ~ 19

Author(s):

Tal Gonen ◽

Rachel Grossman ◽

Razi Sitt ◽

Erez Nossek ◽

Raneen Yanaki ◽

...

Keyword(s):

Supplementary Motor Area ◽

Brain Regions ◽

Tumor Location ◽

Idh1 Mutation ◽

Awake Craniotomy ◽

Additional Risk Factor ◽

Isocitrate Dehydrogenase 1 ◽

Additional Risk ◽

Mutation Status ◽

History Of

Object Intraoperative seizures during awake craniotomy may interfere with patients' ability to cooperate throughout the procedure, and it may affect their outcome. The authors have assessed the occurrence of intraoperative seizures during awake craniotomy in regard to tumor location and the isocitrate dehydrogenase 1 (IDH1) status of the tumor. Methods Data were collected in 137 consecutive patients who underwent awake craniotomy for removal of a brain tumor. The authors performed a retrospective analysis of the incidence of seizures based on the tumor location and its IDH1 mutation status, and then compared the groups for clinical variables and surgical outcome parameters. Results Tumor location was strongly associated with the occurrence of intraoperative seizures. Eleven patients (73%) with tumor located in the supplementary motor area (SMA) experienced intraoperative seizures, compared with 17 (13.9%) with tumors in the other three non-SMA brain regions (p < 0.0001). Interestingly, there was no significant association between history of seizures and tumor location (p = 0.44). Most of the patients (63.6%) with tumor in the SMA region harbored an IDH1 mutation compared with those who had tumors in non-SMA regions. Thirty-one of 52 patients (60%) with a preoperative history of seizures had an IDH1 mutation (p = 0.02), and 15 of 22 patients (68.2%) who experienced intraoperative seizures had an IDH1 mutation (p = 0.03). In a multivariate analysis, tumor location was found as a significant predictor of intraoperative seizures (p = 0.002), and a trend toward IDH1 mutation as such a predictor was found as well (p = 0.06). Intraoperative seizures were not associated with worse outcome. Conclusions Patients with tumors located in the SMA are more prone to develop intraoperative seizures during awake craniotomy compared with patients who have a tumor in non-SMA frontal areas and other brain regions. The IDH1 mutation was more common in SMA region tumors compared with other brain regions, and may be an additional risk factor for the occurrence of intraoperative seizures.

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SURG-19. COMPLETE RESOLUTION OF ADHD AFTER GROSS TOTAL RESECTION OF DYSEMBRYIOPLASTIC NEUROEPITHELIAL TUMOR

Neuro-Oncology ◽

10.1093/neuonc/noaa222.813 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii463-iii464

Author(s):

Luis Angel Arredondo Navarro ◽

Regina Malinali Navarro Martín del Campo ◽

Lorelay Livier Gutiérrez Oliva ◽

Juan Luis Soto Mancilla ◽

Maria De Lourdes De La Mora Carnalla ◽

...

Keyword(s):

Anterior Part ◽

Gross Total Resection ◽

Dysembryoplastic Neuroepithelial Tumor ◽

Histopathological Diagnosis ◽

Total Resection ◽

Left Frontal Lobe ◽

Tonic Seizure ◽

Hyperactivity Disorder ◽

Contrast Enhanced ◽

History Of

Abstract A 3-year-old boy with a history of attention-deficit/hyperactivity disorder (ADHD) presented a single focal tonic seizure. A thorough physical examination revealed no neurological deficit. A contrast enhanced MRI showed an isointense lesion in the anterior part of the cingulate gyrus extending through the left frontal lobe. After initial evaluation, the parents refused surgical treatment and a close follow up was then considered. At the age of five, the ADHD become more evident and the patient was started on methylphenidate. Poor clinical response was seen with the initiation of stimulant. The boy presented a second generalized seizure and the parents agreed surgical management. An interhemispheric approach was then performed and a gross total resection was achieved. The histopathological diagnosis corresponded to a dysembryoplastic neuroepithelial tumor (DNET). Four years after the resection, the patient is seizure free and the ADHD has also resolved without the need of medication. The disappearance of seizures is common after surgical resection of DNET tumors, but this case establishes an association with ADHD.

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ETMR-12. EMBRYONAL TUMOR WITH MULTILAYERED ROSETTES: A SINGLE CENTER EXPERIENCE

Neuro-Oncology ◽

10.1093/neuonc/noaa222.216 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii325-iii325

Author(s):

Sodai Yoshimura ◽

Masahiro Sugawa ◽

Kohei Fukuoka ◽

Makiko Mori ◽

Yuki Arakawa ◽

...

Keyword(s):

Chromosome Region ◽

Medical Center ◽

Occipital Lobe ◽

Gross Total Resection ◽

Intrathecal Therapy ◽

Tumor Diameter ◽

Total Resection ◽

Embryonal Tumor ◽

Presenting Symptoms ◽

The Mean

Abstract BACKGROUND Embryonal tumor with multilayered rosettes (ETMR) is a rare, highly malignant tumor of the central nervous system and is usually diagnosed in children aged <2 years. Currently, because no defined treatment strategy has been reported, treatment regimens are often extrapolated from other embryonal tumors. Therefore, data collection of ETMR cases is important for further understanding EMTR. Here, we present our experience with four patients with ETMR. MATERIAL AND METHODS Patients with a pathological diagnosis of ETMR from 1999 to 2016 at Saitama Children’s Medical Center were included. Their clinical data were retrospectively analyzed. RESULTS This study included four cases of ETMR (one male and three females). The mean age at diagnosis was 29.5 (range, 15–37) months. Presenting symptoms included seizure, hemiparesis, vomiting, and headache. The mean maximal tumor diameter was 42.5 mm. The tumor locations included frontal lobe, temporal lobe, occipital lobe, cerebellum, and brainstem. Gross total resection was achieved in two cases. Fluorescence in situ hybridization analysis demonstrated amplification of 19q13.42 chromosome region in all cases, and diffuse positive expression was observed in the immunohistochemical staining for LIN28A. Systemic postoperative chemotherapy was administered to all patients. Three patients received intrathecal therapy and three were irradiated. The mean overall survival and progression-free survival were 45.3 and 42 months, respectively. Two patients who underwent gross total resection are alive without recurrence. CONCLUSION Complete surgical resection may be an important prognostic factor in patients with ETMR. Further prospective studies are needed to confirm these results.

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