Tolerability of Repeat Awake Craniotomy: A Propensity-Score-Matched Analysis on 607 Consecutive Cases

Abstract

Awake craniotomy is used for addressing lesions adjacent to eloquent brain regions to minimize damage to neurological functions, and to expedite postoperative recovery. Redo (i.e., repeat) awake surgery is not common, but always an option, especially for recurrent tumors. This study investigated the tolerability of redo awake surgery in terms of surgical characteristics and postoperative clinical course. Single-institution cohort study of 607 awake craniotomies by 1 surgeon at Toronto Western Hospital, 2006-2018. Out of 607 surgeries, 501 surgeries were first-time, and 106 surgeries were redo. Between the 2 groups, surgery time was longer in redo cases than first-time cases and the rate of reoperation was higher in the former. Matched propensity cohort analysis included 104 cases each, based on adjustments for age, sex, tumor location, malignancy, and preoperative performance status. This revealed differences again in surgery time (128.0 vs. 111.9 minutes, P= 0.0004) and the reoperation rate (7.4 vs. 1.0%, P= 0.03). The causes of reoperation were infection (3 wound infection and 3 brain abscess) and wound dehiscence (n= 1). There was no significant difference in the length of hospital stay, the rates of postoperative hemorrhage, new postoperative neurological deficits, home discharge, or readmission. Although redo surgery might increase the surgery time and the risk of reoperation due to postoperative infection, it was found to be well tolerated in other aspects overall. With extra care to infection and wound healing, redo awake surgery is a viable option to patients with the same surgical indication as for first-time surgery.