title: Awake craniotomy vs surgery under general anesthesia for resection of supratentorial lesions.
abstract: BACKGROUND
  The use of an awake craniotomy in the treatment of supratentorial lesions is a challenge for both patients and staff in the operation theater.
  
  
  OBJECTIVE
  To assess the safety and effectiveness of an awake craniotomy with brain mapping in comparison with a craniotomy performed under general anesthesia.
  
  
  METHODS
  We prospectively compared 2 groups of patients who underwent surgery for supratentorial lesions: those in whom an awake craniotomy with intraoperative brain mapping was used (AC group, n = 214) and those in whom surgery was performed under general anesthesia (GA group, n = 361, including 72 patients with lesions in eloquent areas). The AC group included lesions in close proximity to the eloquent cortex that were surgically treated on an elective basis.
  
  
  RESULTS
  Globally, the 2 groups were comparable in terms of sex, age, American Society of Anesthesiologists score, pathology, size of lesions, quality of resection, duration of surgery, and neurological outcome, and different in tumor location and preoperative neurological deficits (higher in the AC group). However, specific data analysis of patients with lesions in eloquent areas revealed a significantly better neurological outcome and quality of resection (P < .001) in the AC group than the subgroup of GA patients with lesions in eloquent areas. Surgery was uneventful in AC patients and they were discharged home sooner.
  
  
  CONCLUSIONS
  AC with brain mapping is safe and allows maximal removal of lesions close to functional areas with low neurological complication rates. It provides an excellent alternative to craniotomy under GA.
authors.affiliation: UMR Unité 825, Faculté Paul Sabatier, IFR 96, Centres Hospitalo-Universitaires de Toulouse, Toulouse, France.
authors.forename: Oumar
authors.initials: O
authors.lastname: Sacko
authors.forename: Valérie
authors.initials: V
authors.lastname: Lauwers-Cances
authors.forename: David
authors.initials: D
authors.lastname: Brauge
authors.forename: Musa
authors.initials: M
authors.lastname: Sesay
authors.forename: Adam
authors.initials: A
authors.lastname: Brenner
authors.forename: Franck-Emmanuel
authors.initials: FE
authors.lastname: Roux
mesh_terms: D000768:Anesthesia, General / Q000379:methods* / Q000401:mortality; D001931:Brain Mapping / Q000379:methods* / Q000401:mortality; D003399:Craniotomy / Q000379:methods* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015173:Supratentorial Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D014851:Wakefulness / Q000502:physiology