Continuous physical examination during subcortical resection in awake craniotomy patients: Its usefulness and surgical outcome.
OBJECTIVE
To evaluate the value of physical examination as a monitoring tool during subcortical resection in awake craniotomy patients and surgical outcomes.


METHODS
Authors reviewed medical records of patients underwent awake craniotomy with continuous physical examination for pathology adjacent to the eloquent area.


RESULTS
Between January 2006 and August 2015, there were 37 patients underwent awake craniotomy with continuous physical examination. Pathology was located in the left cerebral hemisphere in 28 patients (75.7%). Thirty patients (81.1%) had neuroepithelial tumors. Degree of resections were defined as total, subtotal, and partial in 16 (43.2%), 11 (29.7%) and 10 (27.0%) patients, respectively. Median follow up duration was 14 months. The reasons for termination of subcortical resection were divided into 3 groups as follows: 1) by anatomical landmark with the aid of neuronavigation in 20 patients (54%), 2) by reaching subcortical stimulation threshold in 8 patients (21.6%), and 3) by abnormal physical examination in 9 patients (24.3%). Among these 3 groups, there were statistically significant differences in the intraoperative (p=0.002) and early postoperative neurological deficit (p=0.005) with the lowest deficit in neuronavigation group. However, there were no differences in neurological outcome at later follow up (3-months p=0.103; 6-months p=0.285). There were no differences in the degree of resection among the groups.


CONCLUSIONS
Continuous physical examination has shown to be of value as an additional layer of monitoring of subcortical white matter during resection and combining several methods may help increase the efficacy of mapping and monitoring of subcortical functions.
Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama IV Rd., Pathumwan, Bangkok, 10330, Thailand. Electronic address: krishnapundha.b@chulahospital.org.
Krishnapundha
K
Bunyaratavej
Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama IV Rd., Pathumwan, Bangkok, 10330, Thailand. Electronic address: nanmed55@hotmail.com.
Sunisa
S
Sangtongjaraskul
Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama IV Rd., Pathumwan, Bangkok, 10330, Thailand. Electronic address: surunchana.l@chulahospital.org.
Surunchana
S
Lerdsirisopon
Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama IV Rd., Pathumwan, Bangkok, 10330, Thailand. Electronic address: lawantuchinda62@gmail.com.
Lawan
L
Tuchinda
D000328:Adult; D001932:Brain Neoplasms / Q000601:surgery*; D003399:Craniotomy / Q000379:methods* / Q000592:standards; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods* / Q000592:standards; D038361:Neuronavigation / Q000379:methods* / Q000592:standards; D017063:Outcome Assessment, Health Care; D014851:Wakefulness
Awake craniotomy; Brain tumor; Cortical stimulation; Intraoperative stimulation; Physical examination; Subcortical mapping