title: Awake craniotomy for brain tumor resection: the rule rather than the exception?
abstract: OBJECTIVE
  Awake craniotomy (AC) has seen an expanded role in brain tumor surgery over the past few decades. AC allows intraoperative cortical mapping and the continuous assessment of neurophysiological parameters, which are otherwise unattainable under general anesthesia (GA). The ability of AC to analyze eloquent brain areas makes it a powerful method for reducing the risks associated with tumor resection, especially in motor and language cortex. We present a review of the literature to examine the benefits and limits of using AC over GA.
  
  
  METHODS
  A literature search was performed using the Medline and PubMed databases from 1970 and 2012 that compared craniotomy for tumor resection under GA and AC. Data of interest included length of hospital stay, operating time, extent of resection, and neurological sequelae.
  
  
  RESULTS
  A total of 8 studies with 951 patients (411 utilizing AC and 540 utilizing GA) were included in this review. Our interpretation of the literature suggests that AC (4 d, n=110) results in a shorter hospital stay than GA (9 d, n=116). Mean extent of resection was slightly less under awake conditions (41%, n=321) versus GA (44%, n=444), and postoperative deficits were less frequent under awake conditions (7%, n=411) versus GA (23%, n=520). Surgery time was slightly less in the AC group (165 min, n=324) versus GA (168 min, n=477).
  
  
  CONCLUSIONS
  Given the effectiveness of AC for resection of eloquent tumors, the data suggests an expanded role for AC in brain tumor surgery regardless of tumor location.
authors.affiliation: Department of Neurological Surgery, University of Miami Hospital, Miami, FL 33125, USA.
authors.forename: Tyler
authors.initials: T
authors.lastname: Brown
authors.forename: Ashish H
authors.initials: AH
authors.lastname: Shah
authors.forename: Amade
authors.initials: A
authors.lastname: Bregy
authors.forename: Nirav H
authors.initials: NH
authors.lastname: Shah
authors.forename: Michael
authors.initials: M
authors.lastname: Thambuswamy
authors.forename: Eric
authors.initials: E
authors.lastname: Barbarite
authors.forename: Thomas
authors.initials: T
authors.lastname: Fuhrman
authors.forename: Ricardo J
authors.initials: RJ
authors.lastname: Komotar
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D005260:Female; D005910:Glioma / Q000601:surgery; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology; D019635:Neurosurgical Procedures / Q000379:methods* / Q000592:standards; D017060:Patient Satisfaction; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D014851:Wakefulness / Q000502:physiology*