Surgical Resection of Gliomas in Motor Cortex: Prognostic Analysis in Awake Craniotomy and General Anesthesia Approaches

Background: The awake craniotomy (AC) for neoplasms in language area has been showed higher rates of success when compared to general anesthesia (GA). However, a question remains regarding its real indication in glioma resection in motor cortex when compared to GA surgery associated to intraoperative monitoring.

Objectives: Discuss the complications, results and prognosis of glioma resection in motor cortex through GA and AC.

Casuistic and Methods: The authors selected retrospectively, from 2014 to 2017, patients affected by gliomas in motor cortex, associated or not to language area, that were surgically treated by GA or AC. The included patients were analyzed for the categorical variables: age, gender, tumor grade, anatomopathological examination, preoperative and postoperative complications, surgical technique performed, side of procedure, functional area affected by tumor, resection level and Karnofsky score. The authors adopted a significance level of p < 0.05 in the statistical analyzes.

Results: The authors showed 65.9% (n = 29) male and 34.1% female (n = 15) in the study, whose average of age was 47.2 + 14.6 years, and average of follow-up was 14.4 + 10.1 months. The tumor grade was classified in low-grade (40.9%, n = 18) and high-grade (59.1%, n = 26). The gross total resection (GTR) was performed in 65.9% (n = 29). The intraoperative and immediate postoperative complications were presented in 30 and 5% of AC and GA group, respectively. The Karnofsky score evaluated during outcome showed statically significant improvement (p < 0.00 in postoperative evaluation of 12 months) in patients underwent to AC when compared to GA group. Fisher’s test showed statically significant association (p = 0.01) between the tumor resection adjacent to motor cortex alone in right hemisphere in both of surgical approaches. While AC was statically significant (p < 0.00) in the resection of motor cortex, associated or not to language area, in left side when compared to GA.

Conclusion: The AC showed lower rates of GTR and significant higher rates of intraoperative and immediate postoperative complications. However, the significant higher rates in the long-term functional outcome (12 months) in patients underwent to AC when compared to GA. Lastly, based in the brain hemisphere, the indication of AC may be implying only in enhance of complications and mortality rates in disturbs adjacent or in right motor area.

No conflict of interest has been declared by the author(s).