Stimulation-related intraoperative seizures during awake surgery: a review of available evidences

  • Elena Roca
  • Johan Pallud
  • Francesco Guerrini
  • Pier Paolo Panciani
  • Marco Fontanella
  • Giannantonio Spena
Short Review


Awake surgery is a well-defined procedure with a very low morbidity. In particular, stimulation-related intraoperative seizure (IOS) is a commonly discussed and serious complication associated with awake surgery. Here, we reviewed the literature on awake surgery and IOS and sought to obtain evidences on the predictive factors of IOS and on the effect of IOS on postoperative outcomes. We conducted a comprehensive search of the Embase, MEDLINE, and Cochrane Central Register of Controlled Trials databases to identify potentially relevant articles from 2000 to 2019. We used combinations of the following search terms: “intraoperative seizure awake craniotomy,” “awake surgery seizures,” and pertinent associations; the search was restricted to publications in English and only to papers published in the last 20 years. The search returned 141 articles, including 39 papers that reported the IOS rate during awake craniotomy. The reported IOS rates ranged between 0 and 24% (mean, 7.7%). Only few studies have assessed the relationships between awake surgery and IOS, and hence, drawing clear conclusions is difficult. Nevertheless, IOS does not cause permanent and severe postoperative deficits, but can affect the patient’s status perioperatively and the hospitalization duration. Anterior tumor location is an important perioperative factor associated with high IOS risk, whereas having seizures at tumor diagnosis does not seem to influence. However, the role of antiepileptic drug administration and prophylaxis remains unclear. In conclusion, given the difficulty in identifying predictors of IOS, we believe that prompt action at onset and awareness of appropriate management methods are vital.


Awake surgery Awake craniotomy Intraoperative seizures Epileptic seizures Gliomas 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All authors confirm adherence to ethical standards.

Informed consent

Not applicable.


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Copyright information

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

Authors and Affiliations

  • Elena Roca
    • 1
    • 2
    • 3
  • Johan Pallud
    • 4
    • 5
    • 6
  • Francesco Guerrini
    • 7
    • 8
  • Pier Paolo Panciani
    • 1
  • Marco Fontanella
    • 1
  • Giannantonio Spena
    • 8
  1. 1.Neurosurgery, Spedali CiviliUniversity of BresciaBresciaItaly
  2. 2.NeurosurgeryUniversity of MilanMilanItaly
  3. 3.BresciaItaly
  4. 4.Department of NeurosurgerySainte-Anne HospitalParisFrance
  5. 5.Paris Descartes UniversitySorbonne Paris CitéParisFrance
  6. 6.Inserm, U1266, IMA-BrainCentre de Psychiatrie et NeurosciencesParisFrance
  7. 7.Unit of Neurosurgery, Department of Clinical, Surgical, Diagnostic and Pediatric SciencesUniversity of PaviaPaviaItaly
  8. 8.NeurosurgeryOspedale Alessandro ManzoniLeccoItaly

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