A Preoperative Scoring System to Predict Function-Based Resection Limitation Due to Insufficient Participation During Awake Surgery.

Autor:	Elia A; Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris , France.; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia , Italy.; Université Paris Cité, Paris , France., Young JS; Department of Neurological Surgery, University of California, San Francisco, California , USA., Simboli GA; Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris , France.; Université Paris Cité, Paris , France., Roux A; Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris , France.; Université Paris Cité, Paris , France.; Inserm, U1266, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris , France., Moiraghi A; Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris , France.; Université Paris Cité, Paris , France.; Inserm, U1266, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris , France., Trancart B; Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris , France.; Université Paris Cité, Paris , France., Al-Adli N; Department of Neurological Surgery, University of California, San Francisco, California , USA., Aboubakr O; Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris , France.; Université Paris Cité, Paris , France., Bedioui A; Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris , France.; Université Paris Cité, Paris , France.; Department of Neurosurgery, Centre Hospitalier Universitaire Caen, Caen , France., Leclerc A; Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris , France.; Université Paris Cité, Paris , France.; Department of Neurosurgery, Centre Hospitalier Universitaire Caen, Caen , France., Planet M; Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris , France.; Université Paris Cité, Paris , France., Parraga E; Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris , France.; Université Paris Cité, Paris , France., Benevello C; Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris , France.; Université Paris Cité, Paris , France., Oppenheim C; Université Paris Cité, Paris , France.; Inserm, U1266, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris , France.; Department of Neuroradiology, Sainte-Anne Hospital, Paris , France., Chretien F; Université Paris Cité, Paris , France.; Inserm, U1266, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris , France.; Department of Neuropathology, Sainte-Anne Hospital, Paris , France., Dezamis E; Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris , France.; Université Paris Cité, Paris , France., Berger MS; Department of Neurological Surgery, University of California, San Francisco, California , USA., Zanello M; Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris , France.; Université Paris Cité, Paris , France.; Inserm, U1266, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris , France., Pallud J; Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris , France.; Université Paris Cité, Paris , France.; Inserm, U1266, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris , France.
Jazyk:	angličtina
Zdroj:	Neurosurgery [Neurosurgery] 2023 Sep 01; Vol. 93 (3), pp. 678-690. Date of Electronic Publication: 2023 Apr 05.
DOI:	10.1227/neu.0000000000002477
Abstrakt:	Background: Failure in achieving a function-based resection related to the insufficient patient's participation is a drawback of awake surgery. Objective: To assess preoperative parameters predicting the risk of patient insufficient intraoperative cooperation leading to the arrest of the awake resection. Methods: Observational, retrospective, multicentric cohort analysis enrolling 384 (experimental dataset) and 100 (external validation dataset) awake surgeries. Results: In the experimental data set, an insufficient intraoperative cooperation occurred in 20/384 patients (5.2%), leading to awake surgery failure in 3/384 patients (ie, no resection, 0.8%), and precluded the achievement of the function-based resection in 17/384 patients (ie, resection limitation, 4.4%). The insufficient intraoperative cooperation significantly reduced the resection rates (55.0% vs 94.0%, P < .001) and precluded a supratotal resection (0% vs 11.3%, P = .017). Seventy years or older, uncontrolled epileptic seizures, previous oncological treatment, hyperperfusion on MRI, and mass effect on midline were independent predictors of insufficient cooperation during awake surgery ( P < .05). An Awake Surgery Insufficient Cooperation score was then assessed: 96.9% of patients (n = 343/354) with a score ≤2 presented a good intraoperative cooperation, while only 70.0% of patients (n = 21/30) with a score >2 presented a good intraoperative cooperation. In the experimental data set, similar date were found: 98.9% of patients (n = 98/99) with a score ≤2 presented a good cooperation, while 0% of patients (n = 0/1) with a score >2 presented a good cooperation. Conclusion: Function-based resection under awake conditions can be safely performed with a low rate of insufficient patient intraoperative cooperation. The risk can be assessed preoperatively by a careful patient selection. (Copyright © Congress of Neurological Surgeons 2023. All rights reserved.)
Databáze:	MEDLINE
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