Subcortical Injury is an Independent Predictor of Worsening Neurological Deficits Following Awake Craniotomy ProceduresSujit S. Prabhu, MD1, Victoria T Trinh1, Komal Shah1, Dima Suki, MD1, Sawaya Raymond1, Daniel K. Fahim, MD11Houston, TX United States Keywords: craniotomy, complications, cortex, risk factor, outcome
Identifying areas of eloquence in the cortex guides surgical planning and entry during awake craniotomy procedures.
We hypothesized that subcortical injury during tumor resection is an important predictor of postoperative neurological deficits compared to cortical injury.
214 patients undergoing awake craniotomy.
A retrospective review of 214 patients undergoing awake craniotomy was carried out in whom preoperative functional magnetic resonance imaging (fMRI) and cortical mapping (CM) were performed. A radiologist blinded to the clinical data reviewed and graded the changes on diffusion weighted imaging (DWI).
A ? 95% volumetric resection was achieved in 75% of cases. In 40% of cases the fMRI was useful in identifying areas of cortical eloquence while intraoperative cortical mapping identified functional areas in 67% of patients. Positive CM compared to negative CM was predictive of worsening neurological deficits in the immediate postoperative period (p=0.03). Intraoperative neurological deficits, during subcortical dissection, was an independent predictor of postoperative deficits both immediately after surgery (p < 0.001) and at 3-months (p <0.001). Significant DWI restriction in the subcortical white matter was predictive of neurological deficits both immediately and at 3 months, p=0.006 and p=0.004 respectively. New or worsening deficits were seen in 40% of patients however at 3 months 13% had a mild neurological deficit.
This is a retrospective study.
Identification of eloquent cortical areas did not seem to prevent neurological deficits in the immediate postoperative period.
Injury during subcortical dissection was a more significant factor in predicting neurological worsening . Project Roles:
S. Prabhu (), V. Trinh (), K. Shah (), D. Suki (), S. Raymond (), D. Fahim ()