title: Intraoperative seizures during awake craniotomy: incidence and consequences: analysis of 477 patients.
abstract: BACKGROUND
  Awake craniotomy (AC) for removal of intra-axial brain tumors is a well-established procedure. However, the occurrence and consequences of intraoperative seizures during AC have not been well characterized.
  
  
  OBJECTIVE
  To analyze the incidence, risk factors, and consequences of seizures during AC.
  
  
  METHODS
  The database of AC at Tel Aviv Medical Center between 2003 to 2011 was reviewed. Occurrences of intraoperative seizures were analyzed with respect to medical history, medications, tumor characteristics, and postoperative outcome.
  
  
  RESULTS
  Of the 549 ACs performed during the index period, 477 with complete records were identified. Sixty patients (12.6%) experienced intraoperative seizures. The AC procedure failed in 11 patients (2.3%) due to seizures. Patients with intraoperative seizures were significantly younger than nonseizing patients (45 ± 14 years vs 52 ± 16 years, P = .003), had a higher incidence of frontal lobe involvement (86% vs % 57%, P < .0001), and had higher prevalence of a history of seizures (P = .008). Short-term motor deterioration developed postoperatively in a higher percentage of patients with intraoperative seizures (20% vs 10.1%, P = .02) with a longer hospitalization period (4.0 ± 3.0 days vs 3.0 ± 3.0 days, P = .045).
  
  
  CONCLUSIONS
  Although in most cases intraoperative seizures will not result in AC failure, the surgical team should be prepared to treat them promptly to avoid intractable seizures. Intraoperative seizures are more common in younger patients with a tumor in the frontal lobe and those with a history of seizures. Moreover, they are associated with a higher incidence of transient postoperative motor deterioration and protracted length of hospital stay.
authors.affiliation: Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Erez
authors.initials: E
authors.lastname: Nossek
authors.forename: Idit
authors.initials: I
authors.lastname: Matot
authors.forename: Tal
authors.initials: T
authors.lastname: Shahar
authors.forename: Ori
authors.initials: O
authors.lastname: Barzilai
authors.forename: Yoni
authors.initials: Y
authors.lastname: Rapoport
authors.forename: Tal
authors.initials: T
authors.lastname: Gonen
authors.forename: Gal
authors.initials: G
authors.lastname: Sela
authors.forename: Rachel
authors.initials: R
authors.lastname: Grossman
authors.forename: Akiva
authors.initials: A
authors.lastname: Korn
authors.forename: Daniel
authors.initials: D
authors.lastname: Hayat
authors.forename: Zvi
authors.initials: Z
authors.lastname: Ram
mesh_terms: D001932:Brain Neoplasms / Q000175:diagnosis / Q000601:surgery*; D015897:Comorbidity; D003399:Craniotomy / Q000706:statistics & numerical data*; D004569:Electroencephalography / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000175:diagnosis / Q000453:epidemiology*; D015996:Survival Rate; D014851:Wakefulness