Assessment of Post-Operative Outcomes of Surgical Excision of Gliomas of the Eloquent Areas of the Brain under Awake versus General Anaesthesia

Surgical excision of eloquent gliomas can be done under general anaesthesia or awake anaesthesia. Surgical excision of eloquent gliomas using awake anaesthesia helps to avoid intra-operative manipulation of the eloquent areas of the brain and thus avoid post-operative neurological deficits.

to compare the operative outcomes of eloquent glioma resection performed under general anaesthesia compared to awake anaesthesia to assess the safety and effectiveness of each intervention.

This systematic review and meta-analysis were conducted in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Metaanalysis Of Observational Studies in Epidemiology (MOOSE) statement. PRISMA and MOOSE are reporting checklists for Authors, Editors, and Reviewers of Meta-analyses of interventional and observational studies. According to International committee of medical journal association (ICJME), reviewers reported their findings according to each of the items listed in those checklists (1).

Seven studies reported the early motor deficit, while the rest of the studies have no data concerning early motor deficit. The overall effect estimates did not favor awake craniotomy over general anesthesia in terms of motor deficit (RR 0.92, 95% CI 0.48– 1.4). The pooled studies showed significant heterogeneity (p = 0.001; I2 =85%.

The use of awake craniotomy for surgical resection of gliomas of the eloquent areas is largely limited to small retrospective studies. Within these studies, awake craniotomy achieves both an acceptable rate of GTR and a low rate of persistent neurological deficits. The results of this study illustrate the potential feasibility of awake craniotomy for surgical resection of gliomas of the eloquent areas and emphasize the need for future prospective studies to better determine its efficacy and outcome.