Glioma surgery with awake language mapping versus generalized anesthesia: a systematic review.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis including non-randomized controlled studies
PubMed 33089447 · doi:10.1007/s10143-020-01418-9
What was done
A systematic review and meta-analysis searched Medline, Embase, Cochrane Library, Chinese Biomedical Literature Database, and grey literature through December 2019. Randomized and non-randomized controlled studies comparing awake craniotomy versus general anesthesia during glioma resection and reporting language and neurological outcomes were included.
What was found
Ten studies with 833 patients were included. Awake craniotomy without electrical stimulation showed no significant differences in language and neurological outcomes compared with general anesthesia. Awake craniotomy with electrical stimulation was associated with lower risk of late (>= 3 months) language deficits (pooled RR = 0.44, 95% CI 0.20-0.96) and late neurological deficits (pooled RR = 0.49, 95% CI 0.30-0.79) versus general anesthesia. Awake craniotomy with electrical stimulation was also associated with better extent of resection (pooled RR = 0.81, 95% CI 0.71-0.92) and shorter hospital stay (pooled weighted mean difference = -1.14, 95% CI -1.80 to -0.48).
Why it matters
This review shows that awake craniotomy improves neurological outcomes and extent of resection over general anesthesia specifically when combined with electrical stimulation mapping.
Limits
The review included non-randomized controlled studies, introducing potential confounding by indication and surgeon selection. Total sample size is relatively small (833 patients across 10 studies), and specific tumor grades, baseline patient deficits, and survival data are not detailed in the abstract.
Cited by
- supports During brain tumor resections in eloquent areas such as the left hemisphere, awake craniotomy with intraoperative speech testing is used to identify functional boundaries and prevent speech deficits.