Glioma surgery with awake language mapping versus generalized anesthesia: a systematic review
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REVIEW
Glioma surgery with awake language mapping versus generalized anesthesia: a systematic review Ling-Hao Bu 1,2,3 & Jie Zhang 1,2,3
&
Jun-Feng Lu 1,2,3 & Jin-Song Wu 1,2,3
Received: 12 July 2020 / Revised: 6 October 2020 / Accepted: 12 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Awake craniotomy with language mapping is being increasingly applied to avoid postoperative language dysfunctions worldwide. However, the effectiveness and reliability of this technique remain unclear due to the paucity of studies comparing the awake craniotomy with general anesthesia. To determine the benefit of awake craniotomy for language, motor, and neurological functions, as well as other clinical outcomes, we searched Medline, Embase, the Cochrane Library, and the Chinese Biomedical Literature Database up to December 2019. Gray literatures were also searched. We included randomized and non-randomized controlled studies comparing awake craniotomy versus general anesthetic resection and reporting the language and neurological outcomes. Ten studies with 833 patients were included in the meta-analysis. The pooled risk ratio (RR) suggested no significant differences in language and neurological outcomes between general anesthesia group and awake craniotomy group without electrical stimulation. Awake craniotomy with electrical stimulation, however, was associated with improved late language and neurological outcomes (≥ 3 months) versus general anesthesia with pooled RR of 0.44 (95% CI = 0.20–0.96) and 0.49 (95% CI = 0.30–0.79), respectively. Awake craniotomy with electrical stimulation was also associated with better extent of resection with the pooled RR of 0.81 (95%CI = 0.71–0.92) and shorter hospital stay duration with the pooled weighted mean difference (WMD) of − 1.14 (95%CI = − 1.80 to − 0.48). This meta-analysis suggested that the application of awake craniotomy with electrical stimulation during glioma resection is associated with lower risks of long-term neurological and language deficits and higher extent of tumor resection, as well as shorter hospital stay duration. Keywords Awake craniotomy . Language mapping . Electrical stimulation . Systematic review
Introduction Gliomas are a heterogeneous group of neoplasms classified by their histological and molecular features [24]. Despite the highly individualized treatment strategies based on the World Health Organization (WHO) gradings of gliomas, maximal safe Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10143-020-01418-9) contains supplementary material, which is available to authorized users. * Jie Zhang [email protected] 1
Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China
2
Institute of Neurosurgery, Fudan University, Shanghai 200040, China
3
Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai 200040, China
resection is always the first recommendation [14, 23, 27, 49, 51]. However, resection of gli
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