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Acta Neurochirurgica

, Volume 161, Issue 2, pp 307–315 | Cite as

Awake craniotomy versus craniotomy under general anesthesia without surgery adjuncts for supratentorial glioblastoma in eloquent areas: a retrospective matched case-control study

  • Jasper Kees Wim GerritsenEmail author
  • Charlotte Lauren Viëtor
  • Dimitris Rizopoulos
  • Joost Willem Schouten
  • Markus Klimek
  • Clemens Maria Franciscus Dirven
  • Arnaud Jean-Pierre Edouard Vincent
Original Article - Brain Tumors
Part of the following topical collections:
  1. Topical Collection on Brain Tumors

Abstract

Background

Awake craniotomy with electrocortical and subcortical mapping (AC) has become the mainstay of surgical treatment of supratentorial low-grade gliomas in eloquent areas, but not as much for glioblastomas.

Objective

This retrospective controlled-matched study aims to determine whether AC increases gross total resections (GTR) and decreases neurological morbidity in glioblastoma patients as compared to resection under general anesthesia (GA, conventional).

Methods

Thirty-seven patients with glioblastoma undergoing AC were 1:3 controlled-matched with 111 patients undergoing GA for glioblastoma resection. The two groups were matched for age, gender, preoperative Karnofsky Performance Score (KPS), preoperative tumor volume, tumor location, and type of adjuvant treatment. Primary outcomes were extent of resection and the rate of postoperative complications. The secondary outcome was overall postoperative survival.

Results

After matching, there were no significant differences in clinical variables between groups. Extent of resection was significantly higher in the AC group: mean extent of resection in the AC group was 94.89% (SD = 10.57) as compared to 70.30% (SD = 28.37) in the GA group (p = 0.0001). Furthermore, the mean rate of late minor postoperative complications in the AC group (0.03; SD = − 0.16) was significantly lower than in the GA group (0.15; SD = 0.39) (p = 0.05). No significant differences between groups were found for the other subgroups of postoperative complications. Moreover, overall postoperative survival did not differ between groups (p = 0.297).

Conclusion

These findings suggest that resection of glioblastoma using AC is associated with significantly greater extent of resection and less late minor postoperative complications as compared with craniotomy under GA without the use of surgery adjuncts. However, due to certain limitations inherent to our study design (selection bias) and the absence of the use of surgery adjuncts in the GA group, we advocate for a prospective study to further build upon this evidence and study the use of AC in glioblastoma patients.

Keywords

Awake craniotomy Glioblastoma Extent of resection Morbidity Mortality 

Abbreviations

AC

Awake craniotomy

CI

Confidence interval

GA

General anesthesia

GBM

Glioblastoma multiforme

GTR

Gross total resection

EOR

Extent of resection

ICU

Intensive care unit

IDH-1

Isocitrate dehydrogenase 1

IQR

Interquartile range

ISM

Intraoperative stimulation mapping

KPS

Karnofsky Performance Status

MRI

Magnetic resonance imaging

RT

Radiotherapy

SD

Standard deviation

WHO

World Health Organization

Abbreviations

chemo

chemotherapy

RT

radiotherapy

n

number

\( \overline{\mathrm{x}} \)

mean

\( \overset{\sim }{\mathrm{x}} \)

median

SD

standard deviation

IQR

interquartile range

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

For this type of study formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

701_2018_3788_MOESM1_ESM.docx (4.4 mb)
ESM 1 (DOCX 4488 kb)

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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Jasper Kees Wim Gerritsen
    • 1
    Email author
  • Charlotte Lauren Viëtor
    • 1
  • Dimitris Rizopoulos
    • 2
  • Joost Willem Schouten
    • 1
  • Markus Klimek
    • 3
  • Clemens Maria Franciscus Dirven
    • 1
  • Arnaud Jean-Pierre Edouard Vincent
    • 1
  1. 1.Department of NeurosurgeryErasmus Medical Center RotterdamRotterdamThe Netherlands
  2. 2.Department of BiostatisticsErasmus Medical Center RotterdamRotterdamThe Netherlands
  3. 3.Department of AnesthesiologyErasmus Medical Center RotterdamRotterdamThe Netherlands

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