A retrospective cohort-matched comparison of conscious sedation versus general anesthesia for supratentorial glioma resection

Clinical article

Restricted access


Glioma resection under conscious (“awake”) sedation (CS) is used for eloquent areas of the brain to minimize postoperative neurological deficits. The objective of this study was to compare the duration of hospital stay, overall hospital cost, perioperative morbidity, and postoperative patient functional status in patients whose gliomas were resected using CS versus general endotracheal anesthesia (GEA).


Twenty-two cases in 20 patients who underwent surgery for cerebral gliomas under CS and a matched cohort of 22 cases in 19 patients who underwent surgery under GEA over a 3-year period were retrospectively evaluated. Criteria for inclusion in the study were as follows: 1) a single cerebral lesion; 2) gross-total resection as evidenced by postoperative Gd-enhanced MR imaging within 48 hours of surgery; 3) a WHO Grade II, III, or IV glioma; 4) a supratentorial lesion location; 5) a Karnofsky Performance Scale score ≥ 70; 6) an operation performed by the same neurosurgeon; and 7) an elective procedure.


The average hospital stay was significantly different between the 2 groups: 3.5 days for patients who underwent CS and 4.6 days for those who underwent GEA. This result translated into a significant decrease in the average inpatient cost after intensive care unit (ICU) care for the CS group compared with the GEA group. Other variables were not significantly different.


Patients undergoing glioma resection using CS techniques have a significantly shorter hospital stay with reduced inpatient hospital expenses after postoperative ICU care.

Abbreviations used in this paper: BIS = Bispectral Index; CS = conscious sedation; GEA = general endotracheal anesthesia; GTR = gross-total resection; ICU = intensive care unit; KPS = Karnofsky Performance Scale; LOS = length of stay; MRC = Medical Research Council; NICU = neurosurgical ICU; OAA/S = Observer's Assessment of Alertness/Sedation Scale.

Article Information

Address correspondence to: E. Antonio Chiocca, M.D., Ph.D., Department of Neurological Surgery, N-1017 Doan Hall, The Ohio State University Medical Center, 410 West Tenth Avenue, Columbus, Ohio 43210. email: EA.Chiocca@osumc.edu.

Please include this information when citing this paper: published online June 18, 2010; DOI: 10.3171/2010.5.JNS1041.

© AANS, except where prohibited by US copyright law.




Boulton MBernstein M: Outpatient brain tumor surgery: innovation in surgical neurooncology. J Neurosurg 108:6496542008


Bulsara KRJohnson JVillavicencio AT: Improvements in brain tumor surgery: the modern history of awake craniotomies. Neurosurg Focus 18:4e52005


Conte VBaratta PTomaselli PSonga VMagni LStocchetti N: Awake neurosurgery: an update. Minerva Anestesiol 74:2892922008


Fleisher LAAnderson GF: Perioperative risk: how can we study the influence of provider characteristics?. Anesthesiology 96:103910412002


Gupta DKChandra PSOjha BKSharma BSMahapatra AKMehta VS: Awake craniotomy versus surgery under general anesthesia for resection of intrinsic lesions of eloquent cortex—a prospective randomised study. Clin Neurol Neurosurg 109:3353432007


Hosmer DWLemeshow S: Applied Logistic Regression New YorkJohn Wiley & Sons1989


July JManninen PLai JYao ZBernstein M: The history of awake craniotomy for brain tumor and its spread into Asia. Surg Neurol 71:6216252009


Lanier WL: Brain tumor resection in the awake patient. Mayo Clin Proc 76:6706722001


Lee IHCulley DJBaxter MGXie ZTanzi RECrosby G: Spatial memory is intact in aged rats after propofol anesthesia. Anesth Analg 107:121112152008


Louis DNOhgaki HWiestler ODCavenee WKBurger PCJouvet A: The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 114:971092007


Meyer FBBates LMGoerss SJFriedman JAWindschitl WLDuffy JR: Awake craniotomy for aggressive resection of primary gliomas located in eloquent brain. Mayo Clin Proc 76:6776872001


Monk TGSaini VWeldon BCSigl JC: Anesthetic management and one-year mortality after noncardiac surgery. Anesth Analg 100:4102005


Monk TGWeldon BCGarvan CWDede DEvan der Aa MTHeilman KM: Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology 108:18302008


Ohgaki H: Epidemiology of brain tumors. Methods Mol Biol 472:3233422009


Ohgaki HKleihues P: Population-based studies on incidence, survival rates, and genetic alterations in astrocytic and oligodendroglial gliomas. J Neuropathol Exp Neurol 64:4794892005


Otani NBjeljac MMuroi CWeniger DKhan NWieser HG: Awake surgery for glioma resection in eloquent areas—Zurich's experience and review. Neurol Med Chir (Tokyo) 45:5015112005


Pandharipande PPPun BTHerr DLMaze MGirard TDMiller RR: Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA 298:264426532007


Price CCGarvan CWMonk TG: Type and severity of cognitive decline in older adults after noncardiac surgery. Anesthesiology 108:8172008


Riker RRShehabi YBokesch PMCeraso DWisemandle WKoura F: Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA 301:4894992009


Serletis DBernstein M: Prospective study of awake craniotomy used routinely and nonselectively for supratentorial tumors. J Neurosurg 107:162007


Silber JHKennedy SKEven-Shoshan OChen WMosher REShowan AM: Anesthesiologist board certification and patient outcomes. Anesthesiology 96:104410522002


Steinmetz JChristensen KBLund TLohse NRasmussen LS: Long-term consequences of postoperative cognitive dysfunction. Anesthesiology 110:5485552009


Taylor MDBernstein M: Awake craniotomy with brain mapping as the routine surgical approach to treating patients with supratentorial intraaxial tumors: a prospective trial of 200 cases. J Neurosurg 90:35411999


Tonn JC: Awake craniotomy for monitoring of language function: benefits and limits. Acta Neurochir (Wien) 149:119711982007


Wei HLiang GYang HWang QHawkins BMadesh M: The common inhalational anesthetic isoflurane induces apoptosis via activation of inositol 1,4,5-trisphosphate receptors. Anesthesiology 108:2512602008


Whittle IRBorthwick SHaq N: Brain dysfunction following ‘awake’ craniotomy, brain mapping and resection of glioma. Br J Neurosurg 17:1301372003




All Time Past Year Past 30 Days
Abstract Views 80 80 24
Full Text Views 139 139 10
PDF Downloads 100 100 16
EPUB Downloads 0 0 0


Google Scholar