title: Awake craniotomy for brain lesions within and near the primary motor area: A retrospective analysis of factors associated with worsened paresis in 102 consecutive patients.
abstract: BACKGROUND
  We analyzed factors associated with worsened paresis in a large series of patients with brain lesions located within or near the primary motor area (M1) to establish protocols for safe, awake craniotomy of eloquent lesions.
  
  
  METHODS
  We studied patients with brain lesions involving M1, the premotor area (PMA) and the primary sensory area (S1), who underwent awake craniotomy (n = 102). In addition to evaluating paresis before, during, and one month after surgery, the following parameters were analyzed: Intraoperative complications; success or failure of awake surgery; tumor type (A or B), tumor location, tumor histology, tumor size, and completeness of resection.
  
  
  RESULTS
  Worsened paresis at one month of follow-up was significantly associated with failure of awake surgery, intraoperative complications and worsened paresis immediately after surgery, which in turn was significantly associated with intraoperative worsening of paresis. Intraoperative worsening of paresis was significantly related to preoperative paresis, type A tumor (motor tract running in close proximity to and compressed by the tumor), tumor location within or including M1 and partial removal (PR) of the tumor.
  
  
  CONCLUSIONS
  Successful awake surgery and prevention of deterioration of paresis immediately after surgery without intraoperative complications may help prevent worsening of paresis at one month. Factors associated with intraoperative worsening of paresis were preoperative motor deficit, type A and tumor location in M1, possibly leading to PR of the tumor.
authors.affiliation: Department of Neurosurgery, Komagome Metropolitan Hospital, 3-18-22 Hon-komagome, Bunkyo-ku, Tokyo 113-8677, Japan.
authors.forename: Nobusada
authors.initials: N
authors.lastname: Shinoura
authors.affiliation: Department of Psychology, Chuo University of Literature, 742-1 Higashi-nakano, Hachioji City, Tokyo 192-0393, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Midorikawa
authors.affiliation: Department of Neurosurgery, Komagome Metropolitan Hospital, 3-18-22 Hon-komagome, Bunkyo-ku, Tokyo 113-8677, Japan.
authors.forename: Ryoji
authors.initials: R
authors.lastname: Yamada
authors.affiliation: Department of Neurosurgery, Komagome Metropolitan Hospital, 3-18-22 Hon-komagome, Bunkyo-ku, Tokyo 113-8677, Japan.
authors.forename: Taijun
authors.initials: T
authors.lastname: Hana
authors.affiliation: Department of Neurosurgery, Komagome Metropolitan Hospital, 3-18-22 Hon-komagome, Bunkyo-ku, Tokyo 113-8677, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Saito
authors.affiliation: Department of Psychology, Chuo University of Literature, 742-1 Higashi-nakano, Hachioji City, Tokyo 192-0393, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Hiromitsu
authors.affiliation: Department of Psychology, Chuo University of Literature, 742-1 Higashi-nakano, Hachioji City, Tokyo 192-0393, Japan.
authors.forename: Chisato
authors.initials: C
authors.lastname: Itoi
authors.affiliation: Department of Psychology, Chuo University of Literature, 742-1 Higashi-nakano, Hachioji City, Tokyo 192-0393, Japan.
authors.forename: Syoko
authors.initials: S
authors.lastname: Saito
authors.affiliation: Department of Radiologic Technology, Tokyo Metropolitan University of Health Sciences, 7-2-10 Higashiogu, Arakawa-ku, Tokyo 116-8553, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yagi
keywords: Awake surgery; brain tumor; complication; failure; neurological deficit; primary motor area