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.
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.
Authors: Karim ReFaey; Shashwat Tripathi; Adip G Bhargav; Sanjeet S Grewal; Erik H Middlebrooks; David S Sabsevitz; Mark Jentoft; Peter Brunner; Adela Wu; William O Tatum; Anthony Ritaccio; Kaisorn L Chaichana; Alfredo Quinones-Hinojosa Journal: J Neurooncol Date: 2020-06-10 Impact factor: 4.130
Authors: Giannantonio Spena; Elena Roca; Francesco Guerrini; Pier Paolo Panciani; Lorenzo Stanzani; Andrea Salmaggi; Sabino Luzzi; Marco Fontanella Journal: J Neurooncol Date: 2019-09-24 Impact factor: 4.130
Authors: Giannantonio Spena; Philippe Schucht; Kathleen Seidel; Geert-Jan Rutten; Christian Franz Freyschlag; Federico D'Agata; Emanule Costi; Francesca Zappa; Marco Fontanella; Denys Fontaine; Fabien Almairac; Michele Cavallo; Pasquale De Bonis; Gerardo Conesa; Nicholas Foroglou; Santiago Gil-Robles; Emanuel Mandonnet; Juan Martino; Thomas Picht; Catarina Viegas; Michel Wager; Johan Pallud Journal: Neurosurg Rev Date: 2016-08-01 Impact factor: 3.042
Authors: Elena Roca; Johan Pallud; Francesco Guerrini; Pier Paolo Panciani; Marco Fontanella; Giannantonio Spena Journal: Neurosurg Rev Date: 2019-12-03 Impact factor: 3.042