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J Neurol Surg A Cent Eur Neurosurg 2017; 78(04): 368-373
DOI: 10.1055/s-0036-1586252
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Operative Strategies during Awake Surgery Affect Deterioration of Paresis a Month after Surgery for Brain Lesions in the Primary Motor Area

Nobusada Shinoura
1   Department of Neurosurgery, Komagome Metropolitan Hospital, Tokyo, Japan
,
Akira Midorikawa
2   Department of Psychology, Chuo University of Literature, Tokyo, Japan
,
Ryoji Yamada
1   Department of Neurosurgery, Komagome Metropolitan Hospital, Tokyo, Japan
,
Kentaro Hiromitsu
2   Department of Psychology, Chuo University of Literature, Tokyo, Japan
,
Chihiro Itoi
2   Department of Psychology, Chuo University of Literature, Tokyo, Japan
,
Shoko Saito
2   Department of Psychology, Chuo University of Literature, Tokyo, Japan
,
Kazuo Yagi
3   Department of Radiologic Technology, Tokyo Metropolitan University of Health Sciences, Tokyo, Japan
› Author Affiliations
Further Information

Publication History

10 June 2015

27 May 2016

Publication Date:
18 October 2016 (online)

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Abstract

Introduction We analyzed factors associated with worsened paresis at 1-month follow-up in patients with brain tumors located in the primary motor area (M1) to establish protocols for safe awake craniotomy for M1 lesions.

Methods Patients with M1 brain tumors who underwent awake surgery in our hospital (n = 61) were evaluated before, during, and immediately and 1 month after surgery for severity of paresis, tumor location, extent of resection, complications, preoperative motor strength, histology, and operative strategies (surgery stopped or continued after deterioration of motor function).

Results Worsened paresis at 1-month follow-up was significantly associated with worsened paresis immediately after surgery and also with operative strategy. Specifically, when motor function deteriorated during awake surgery and did not recover within 5 to 10 minutes, no deterioration was observed at 1-month follow-up in cases where we stopped surgery, whereas 6 of 13 cases showed deteriorated motor function at 1-month follow-up in cases where we continued surgery.

Conclusion Stopping tumor resection on deterioration of motor function during awake surgery may help prevent worsened paresis at 1-month follow-up.

Keywords

awake surgery - brain tumor - motor function - operative strategy - primary motor area
 

  • References

  • 1 Taylor MD, Bernstein M. Awake craniotomy with brain mapping as the routine surgical approach to treating patients with supratentorial intraaxial tumors: a prospective trial of 200 cases. J Neurosurg 1999; 90 (01) 35-41
    CrossrefPubMedGoogle Scholar
  • 2 Kim SS, McCutcheon IE, Suki D. , et al. Awake craniotomy for brain tumors near eloquent cortex: correlation of intraoperative cortical mapping with neurological outcomes in 309 consecutive patients. Neurosurgery 2009; 64 (05) 836-845 ; discussion 345–346
    CrossrefPubMedGoogle Scholar
  • 3 Pereira LC, Oliveira KM, L'Abbate GL, Sugai R, Ferreira JA, da Motta LA. Outcome of fully awake craniotomy for lesions near the eloquent cortex: analysis of a prospective surgical series of 79 supratentorial primary brain tumors with long follow-up. Acta Neurochir (Wien) 2009; 151 (10) 1215-1230
    CrossrefPubMedGoogle Scholar
  • 4 Peruzzi P, Bergese SD, Viloria A, Puente EG, Abdel-Rasoul M, Chiocca EA. A retrospective cohort-matched comparison of conscious sedation versus general anesthesia for supratentorial glioma resection. Clinical article. J Neurosurg 2011; 114 (03) 633-639
    CrossrefPubMedGoogle Scholar
  • 5 Sacko O, Lauwers-Cances V, Brauge D, Sesay M, Brenner A, Roux FE. Awake craniotomy vs surgery under general anesthesia for resection of supratentorial lesions. Neurosurgery 2011; 68 (05) 1192-1198 ; discussion 1198–1199
    CrossrefPubMedGoogle Scholar
  • 6 Shinoura N, Yoshida M, Yamada R. , et al. Awake surgery with continuous motor testing for resection of brain tumors in the primary motor area. J Clin Neurosci 2009; 16 (02) 188-194
    CrossrefPubMedGoogle Scholar
  • 7 Shinoura N, Midorikawa A, Yamada R. , et al. Awake craniotomy for brain lesions within and near the primary motor area: a retrospective analysis of factors associated with worsened paresis in 102 consecutive patients. Surg Neurol Int 2013; 4: 149
    CrossrefPubMedGoogle Scholar
  • 8 Shinoura N, Yamada R, Kodama T, Suzuki Y, Takahashi M, Yagi K. Preoperative fMRI, tractography and continuous task during awake surgery for maintenance of motor function following surgical resection of metastatic tumor spread to the primary motor area. Minim Invasive Neurosurg 2005; 48 (02) 85-90
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Shinoura N, Yamada R, Suzuki Y. , et al. Functional magnetic resonance imaging is more reliable than somatosensory evoked potential or mapping for the detection of the primary motor cortex in proximity to a tumor. Stereotact Funct Neurosurg 2007; 85 (2–3): 99-105
    CrossrefPubMedGoogle Scholar
  • 10 Berger MS, Kincaid J, Ojemann GA, Lettich E. Brain mapping techniques to maximize resection, safety, and seizure control in children with brain tumors. Neurosurgery 1989; 25 (05) 786-792
    CrossrefPubMedGoogle Scholar
  • 11 Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 2013; 48 (03) 452-458
    CrossrefPubMedGoogle Scholar
  • 12 Pinsker MO, Nabavi A, Mehdorn HM. Neuronavigation and resection of lesions located in eloquent brain areas under local anesthesia and neuropsychological-neurophysiological monitoring. Minim Invasive Neurosurg 2007; 50 (05) 281-284
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Spena G, Nava A, Cassini F. , et al. Preoperative and intraoperative brain mapping for the resection of eloquent-area tumors. A prospective analysis of methodology, correlation, and usefulness based on clinical outcomes. Acta Neurochir (Wien) 2010; 152 (11) 1835-1846
    CrossrefPubMedGoogle Scholar
  • 14 Chacko AG, Thomas SG, Babu KS. , et al. Awake craniotomy and electrophysiological mapping for eloquent area tumours. Clin Neurol Neurosurg 2013; 115 (03) 329-334
    CrossrefPubMedGoogle Scholar
  • 15 Spena G, D'Agata F, Panciani PP, Buglione di Monale M, Fontanella MM. Supratentorial gliomas in eloquent areas: which parameters can predict functional outcome and extent of resection?. PLoS One 2013; 8 (12) e80916
    CrossrefPubMedGoogle Scholar
  • 16 Nossek E, Matot I, Shahar T. , et al. Failed awake craniotomy: a retrospective analysis in 424 patients undergoing craniotomy for brain tumor. J Neurosurg 2013; 118 (02) 243-249
    CrossrefPubMedGoogle Scholar
  • 17 De Witt Hamer PC, Robles SG, Zwinderman AH, Duffau H, Berger MS. Impact of intraoperative stimulation brain mapping on glioma surgery outcome: a meta-analysis. J Clin Oncol 2012; 30 (20) 2559-2565
    CrossrefPubMedGoogle Scholar
  • 18 Trinh VT, Fahim DK, Shah K. , et al. Subcortical injury is an independent predictor of worsening neurological deficits following awake craniotomy procedures. Neurosurgery 2013; 72 (02) 160-169
    CrossrefPubMedGoogle Scholar
  • 19 Almenawer SA, Badhiwala JH, Alhazzani W. , et al. Biopsy versus partial versus gross total resection in older patients with high-grade glioma: a systematic review and meta-analysis. Neuro Oncol 2015; 17 (06) 868-881
    CrossrefPubMedGoogle Scholar
  • 20 McCrea HJ, Bander ED, Venn RA. , et al. Sex, age, anatomic location, and extent of resection influence outcomes in children with high-grade glioma. Neurosurgery 2015; 77 (03) 443-452 ; discussion 452–453
    CrossrefPubMedGoogle Scholar
  • 21 McGirt MJ, Chaichana KL, Attenello FJ. , et al. Extent of surgical resection is independently associated with survival in patients with hemispheric infiltrating low-grade gliomas. Neurosurgery 2008; 63 (04) 700-707 ; author reply 707–708
    CrossrefPubMedGoogle Scholar
  • 22 McGirt MJ, Chaichana KL, Gathinji M. , et al. Independent association of extent of resection with survival in patients with malignant brain astrocytoma. J Neurosurg 2009; 110 (01) 156-162
    CrossrefPubMedGoogle Scholar
  • 23 Salvati M, Pichierri A, Piccirilli M. , et al. Extent of tumor removal and molecular markers in cerebral glioblastoma: a combined prognostic factors study in a surgical series of 105 patients. J Neurosurg 2012; 117 (02) 204-211
    CrossrefPubMedGoogle Scholar
  • 24 Smith JS, Chang EF, Lamborn KR. , et al. Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. J Clin Oncol 2008; 26 (08) 1338-1345
    CrossrefPubMedGoogle Scholar
  • 25 Wilden JA, Voorhies J, Mosier KM, O'Neill DP, Cohen-Gadol AA. Strategies to maximize resection of complex, or high surgical risk, low-grade gliomas. Neurosurg Focus 2013; 34 (02) E5
    PubMedGoogle Scholar