Awake craniotomy for brain tumor resection is becoming a standard of care for lesions residing within or in close proximity to regions presumed to have language or sensorimotor function. Evidence shows an improved outcome including greater extent of resection, fewer late neurological deficits, shorter hospital stay, and longer survival after awake brain tumor resection compared with surgery under general anesthesia. The surgeon’s ability to maximize tumor resection within the constraint of preserving neurological function by intraoperative stimulation mapping in an awake patient is credited for this advantageous result. It is possible that the care provided by anesthesiologists, especially the avoidance of certain components of general endotracheal anesthesia, may also be important in the outcome of awake brain tumor resection. We present our interpretation of the evidence that we believe substantiates this proposition. However, due to the lack of direct evidence based on randomized-controlled trials and the heterogeneity of anesthetic techniques used for awake craniotomy, our perspective is largely speculative and hypothesis generating that needs to be validated or refuted by future quality research.
Departments of *Anesthesia and Perioperative Care
†Neurological Surgery, University of California San Francisco, San Francisco, CA
Supported by the Inaugural Anesthesia Department Awards for Seed Funding for Clinically Oriented Research Projects from the Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA.
The authors have no funding or conflicts of interest to disclose.
Reprints: Lingzhong Meng, MD, Department of Anesthesia and Perioperative Care, University of California San Francisco, 521 Parnassus Avenue, Suite C450, San Francisco, CA 94143 (e-mail: email@example.com).
Received November 17, 2014
Accepted February 19, 2015