Awake craniotomy feasible, safe in patients with drug-resistant focal epilepsy

Performing craniotomy for drug-resistant focal epilepsy while a patient is awake appears feasible and does not increase the risk of adverse events, including intraoperative epileptic seizures, according to a retrospective, single-centre cohort study.

The study included 588 consecutive patients who underwent awake craniotomies. Outcomes were assessed in three specific groups of patients with drug-resistant focal epilepsy: (1) those with low-grade, developmental, epilepsy-associated brain tumour and an associated nontumoral epileptogenic brain lesion group (n=46); (2) those with ≥2 years of uncontrolled epileptic seizures (n=32); (3) and those on ≥2 antiseizure medications (n=77). For each subgroup being studied, the control group comprised all the other patients in the study who did not have that specific characteristic.

Feasibility outcomes were time to awakening, intraoperative cooperation, and procedure abortion. Safety outcomes were surgery-related risks and intraoperative and early postoperative epileptic seizures.

Comparing patients with drug-resistant focal epilepsy across the three subgroups and controls, similar rates were observed for late awakening (6.5 percent to 14.3 percent vs 8.7 percent to 9.8 percent; p=0.450, p=0.972, and p=0.143), insufficient intraoperative cooperation (0 percent to 9.1 percent vs 5.0 percent to 6.1 percent; p=0.019, p=0.345, and p=0.173), intraoperative epileptic seizures (4.3 percent to 9.1 percent vs 2.7 percent to 5.0 percent; p=0.226 and p=0.529), and early postoperative epileptic seizures (13.0 percent to 19.3 percent vs 9.8 percent to 10.6 percent; p=0.613, p=0.143, and p=0.078).

However, the subgroup of patients with drug-resistant focal epilepsy who presented with a ≥2-year history of uncontrolled epileptic seizures was more likely to experience intraoperative epileptic seizures compared with controls (12.9 percent vs 2.3 percent; p<0.001).

None of the patients required abortion of the awake procedure because of epilepsy.