Stimulation-related intraoperative seizures during awake surgery: a review of available evidences
- 18 Downloads
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.
KeywordsAwake 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.
All authors confirm adherence to ethical standards.
- 1.Kim SS, McCutcheon IE, Suki D et al (2009) Awake craniotomy for brain tumors near eloquent cortex: correlation of intraoperative cortical mapping with neurological outcomes in 309 consecutive patients. Neurosurgery 64(05):836–845; discussion 345–346. https://doi.org/10.1227/01.NEU.0000342405.80881.81 CrossRefPubMedGoogle Scholar
- 2.Spena G, Nava A, Cassini F, Pepoli A, Bruno M, D’Agata F, Cauda F, Sacco K, Duca S, Barletta L, Versari P (2010) Preoperative and intraoperative brain mapping for the resection of eloquent area tumors. A prospective analysis of methodology, correlation, and usefulness based on clinical outcomes. Acta Neurochir 152:1835–1846. https://doi.org/10.1007/s00701-010-0764-9 CrossRefPubMedGoogle Scholar
- 3.Spena G, D’Agata F, Panciani PP, Buglione di Monale M, Fontanella MM (2013) Supratentorial gliomas in eloquent areas: which parameters can predict functional outcome and extent of resection? PLoS ONE 8:e80916. https://doi.org/10.1371/journal.pone.0080916 eCollection 2013CrossRefPubMedPubMedCentralGoogle Scholar
- 4.Spena G, Garbossa D, Panciani PP, Griva F, Fontanella MM (2013) Purely subcortical tumors in eloquent areas: awake surgery and cortical and subcortical electrical stimulation (CSES) ensure safe and effective surgery. Clin Neurol Neurosurg 115(9):1595–1601. https://doi.org/10.1016/j.clineuro.2013.02.006 CrossRefPubMedGoogle Scholar
- 5.Zanello M, Meyer B, Still M, Goodden JR, Colle H, Schichor C, Bello L, Wager M, Smits A, Rydenhag B, Tate M, Metellus P, Hamer PW, Spena G, Capelle L, Mandonnet E, Robles SG, Sarubbo S, Martino González J, Fontaine D, Reyns N, Krieg SM, Huberfeld G, Wostrack M, Colle D, Robert E, Noens B, Muller P, Yusupov N, Rossi M, Conti Nibali M, Papagno C, Visser V, Baaijen H, Galbarritu L, Chioffi F, Bucheli C, Roux A, Dezamis E, Duffau H, Pallud J (2019) Surgical resection of cavernous angioma located within eloquent brain areas: international survey of the practical management among 19 specialized centers. Seizure 69:31–40. https://doi.org/10.1016/j.seizure.2019.03.022 CrossRefPubMedGoogle Scholar
- 9.Nossek E, Matot I, Shahar T et al (2013) Intraoperative seizures during awake craniotomy: incidence and consequences: analysis of 477 patients. Neurosurgery 73(01):135–140; discussion 140. https://doi.org/10.1227/01.neu.0000429847.91707.97 CrossRefPubMedGoogle Scholar
- 10.Choi BD, Lee DK, Yang JC, Ayinon CM, Lee CK, Maus D, Carter BS, Barker FG, Jones PS, Nahed BV, Cahill DP, See RB, Simon MV, Curry WT (2019) (2019). Receptor tyrosine kinase gene amplification is predictive of intraoperative seizures during glioma resection with functional mapping. J Neurosurg 29:1–7. https://doi.org/10.3171/2018.12.JNS182700 CrossRefGoogle Scholar
- 12.Eseonu CI, Eguia F, Garcia O, Kaplan PW, Quiñones-Hinojosa A (2017) Comparative analysis of monotherapy versus duotherapy antiseizure drug management for postoperative seizure control in patients undergoing an awake craniotomy. J Neurosurg 128(6):1661–1667. https://doi.org/10.3171/2017.1.JNS162913 CrossRefPubMedGoogle Scholar
- 15.Boetto J, Bertram L, Moulinié G, Herbet G, Moritz-Gasser S, Duffau H (2015) Low rate of intraoperative seizures during awake craniotomy in a prospective cohort with 374 supratentorial brain lesions: electrocorticography is not mandatory. World Neurosurg 84(06):1838–1844. https://doi.org/10.1016/j.wneu.2015.07.075 CrossRefPubMedGoogle Scholar
- 18.Skardelly M, Brendle E, Noell S et al (2015) Predictors of preoperative and early postoperative seizures in patients with intra-axial primary and metastatic brain tumors: a retrospective observational single center study. Ann Neurol 78(06):917–928. https://doi.org/10.1002/ana.24522 CrossRefPubMedGoogle Scholar
- 19.Spena G, Schucht P, Seidel K, Rutten GJ, Freyschlag CF, D'Agata F, Costi E, Zappa F, Fontanella M, Fontaine D, Almairac F, Cavallo M, De Bonis P, Conesa G, Foroglou N, Gil-Robles S, Mandonnet E, Martino J, Picht T, Viegas C, Wager M, Pallud J (2017) Brain tumors in eloquent areas: a European multicenter survey of intraoperative mapping techniques, intraoperative seizures occurrence, and antiepileptic drug prophylaxis. Neurosurg Rev 40(2):287–298. https://doi.org/10.1007/s10143-016-0771-2 CrossRefPubMedGoogle Scholar
- 21.Wang YC, Lee CC, Takami H, Shen S, Chen KT, Wei KC, Wu MH, Worrell G, Chen PY (2019) Awake craniotomies for epileptic gliomas: intraoperative and postoperative seizure control and prognostic factors. J Neurooncol 142(3):577–586. https://doi.org/10.1007/s11060-019-03131-0 CrossRefPubMedGoogle Scholar
- 23.Pallud J, Le Van Quyen M, Bielle F, Pellegrino C, Varlet P, Labussiere M, Cresto N, Dieme MJ, Baulac M, Duyckaerts C, Kourdougli N, Chazal G, Devaux B, Rivera C, Miles R, Capelle L, Huberfeld G (2014) Cortical GABAergic excitation contributes to epileptic activities around human glioma. Sci Transl Med 6(244):244ra89. https://doi.org/10.1126/scitranslmed.3008065 CrossRefPubMedPubMedCentralGoogle Scholar