Tzy Harn Chua1, Angela An Qi See2, Beng Ti Ang3, Nicolas Kon Kam King4. 1. School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia. 2. Department of Neurosurgery, Singapore General Hospital, Singapore; Department of Neurosurgery, National Neuroscience Institute, Singapore. 3. Department of Neurosurgery, Singapore General Hospital, Singapore; Department of Neurosurgery, National Neuroscience Institute, Singapore; Duke-NUS Medical School, Singapore, Singapore. 4. Department of Neurosurgery, Singapore General Hospital, Singapore; Department of Neurosurgery, National Neuroscience Institute, Singapore; Duke-NUS Medical School, Singapore, Singapore. Electronic address: nicolas.kon.k.k@singhealth.com.sg.
Abstract
BACKGROUND: Surgery for brain metastases aims to reduce mass effect and achieve local control through maximizing resection. There is increasing recognition that awake craniotomy (AC) is especially relevant for resection of brain metastases in eloquent areas. This study seeks to examine the neurologic outcomes of using AC for brain metastases resection. METHODS: A systematic search for studies examining the role of AC in patients with brain metastases was conducted via PubMed without limitations on the year of publication, language, or study design, using the following search terms: (cerebral OR brain) and (metastases OR tumor) and (awake OR intraoperative OR eloquent OR supramarginal). Studies were included if patients underwent AC for resection of brain metastases and data on pre- and postoperative neurologic function were available. RESULTS: Seven studies published between 2001 and 2017 with 104 patients who underwent 107 ACs were identified. Gross total resection was achieved in 61% of patients, supramarginal resection was achieved in 32%, and subtotal resection was achieved in 7%. Immediately after operation, 73% of patients experienced no change or improvement in neurologic outcomes, whereas 27% experienced worsening. In the long term, 96% of those with postoperative worsening of function experienced improvements in neurologic function. CONCLUSIONS: Most patients experienced improvements in neurologic function immediately after AC, and most patients that experienced short-term worsening of neurologic function after the procedure showed excellent recovery. AC should be considered as a technique to optimize outcomes in brain metastases in eloquent areas.
BACKGROUND: Surgery for brain metastases aims to reduce mass effect and achieve local control through maximizing resection. There is increasing recognition that awake craniotomy (AC) is especially relevant for resection of brain metastases in eloquent areas. This study seeks to examine the neurologic outcomes of using AC for brain metastases resection. METHODS: A systematic search for studies examining the role of AC in patients with brain metastases was conducted via PubMed without limitations on the year of publication, language, or study design, using the following search terms: (cerebral OR brain) and (metastases OR tumor) and (awake OR intraoperative OR eloquent OR supramarginal). Studies were included if patients underwent AC for resection of brain metastases and data on pre- and postoperative neurologic function were available. RESULTS: Seven studies published between 2001 and 2017 with 104 patients who underwent 107 ACs were identified. Gross total resection was achieved in 61% of patients, supramarginal resection was achieved in 32%, and subtotal resection was achieved in 7%. Immediately after operation, 73% of patients experienced no change or improvement in neurologic outcomes, whereas 27% experienced worsening. In the long term, 96% of those with postoperative worsening of function experienced improvements in neurologic function. CONCLUSIONS: Most patients experienced improvements in neurologic function immediately after AC, and most patients that experienced short-term worsening of neurologic function after the procedure showed excellent recovery. AC should be considered as a technique to optimize outcomes in brain metastases in eloquent areas.
Authors: Martin A Proescholdt; Petra Schödel; Christian Doenitz; Tobias Pukrop; Julius Höhne; Nils Ole Schmidt; Karl-Michael Schebesch Journal: Cancers (Basel) Date: 2021-03-31 Impact factor: 6.639
Authors: Borys M Kwinta; Aneta M Myszka; Monika M Bigaj; Roger M Krzyżewski; Anna Starowicz-Filip Journal: Neurol Sci Date: 2020-08-17 Impact factor: 3.307