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Intraoperative Seizures During Awake Craniotomy: Incidence and Consequences: Analysis of 477 Patients

Nossek, Erez MD*; Matot, Idit MD‡,§; Shahar, Tal MD*; Barzilai, Ori MD*; Rapoport, Yoni§; Gonen, Tal MA*; Sela, Gal MA*; Grossman, Rachel MD*; Korn, Akiva MMedSc, D-ABNM*; Hayat, Daniel MD; Ram, Zvi MD*,§

doi: 10.1227/01.neu.0000429847.91707.97
Research-Human-Clinical Studies

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).

CONCLUSION: 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.

ABBREVIATIONS: AC, awake craniotomy

AED, antiepileptic drug

ECoG, electrocorticography

OR, odds ratio

Departments of *Neurosurgery and

Anesthesia and Intensive Care, Tel Aviv Medical Center,

§Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

Correspondence: Zvi Ram, MD, Department of Neurosurgery, Tel Aviv Medical Center, Sackler Medical School, Tel Aviv University, 6 Weizman Street, Tel Aviv 64239, Israel. E-mail:

Received November 05, 2012

Accepted March 13, 2013

Copyright © by the Congress of Neurological Surgeons