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Awake Craniotomy During Pregnancy: A Systematic Review of the Published Literature Publisher Pubmed



Mofatteh M1, 2 ; Mashayekhi MS3, 4, 5 ; Arfaie S6, 7, 8 ; Wei H9 ; Kazerouni A10 ; Skandalakis GP11 ; Pourrashidi A12 ; Baiad A13 ; Elkaim L14 ; Lam J9 ; Palmisciano P15 ; Su X16 ; Liao X17, 18 ; Das S19 Show All Authors
Authors
  1. Mofatteh M1, 2
  2. Mashayekhi MS3, 4, 5
  3. Arfaie S6, 7, 8
  4. Wei H9
  5. Kazerouni A10
  6. Skandalakis GP11
  7. Pourrashidi A12
  8. Baiad A13
  9. Elkaim L14
  10. Lam J9
  11. Palmisciano P15
  12. Su X16
  13. Liao X17, 18
  14. Das S19
  15. Ashkan K2, 20, 21, 22, 23
  16. Cohengadol AA24, 25, 26
Show Affiliations
Authors Affiliations
  1. 1. School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, United Kingdom
  2. 2. Neuro International Collaboration (NIC), London, United Kingdom
  3. 3. Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
  4. 4. Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
  5. 5. Neuro International Collaboration (NIC), Ottawa, ON, Canada
  6. 6. Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
  7. 7. Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, CA, United States
  8. 8. Neuro International Collaboration (NIC), Montreal, QC, Canada
  9. 9. Department of 120 Emergency Command Center, Foshan Sanshui District People’s Hospital, Guangdong Province, Foshan, China
  10. 10. Memorial University of Newfoundland, St. John’s, NL, Canada
  11. 11. First Department of Neurosurgery, Evangelismos General Hospital, National and Kapodistrian University of Athens, Athens, Greece
  12. 12. Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
  13. 13. Faculty of Medicine, McGill University, Montreal, QC, Canada
  14. 14. Montreal Neurological Institute and Hospital, Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
  15. 15. University of Cincinnati College of Medicine, Cincinnati, OH, United States
  16. 16. Obstetrical Department, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
  17. 17. Department of Neurosurgery, Foshan Sanshui District People’s Hospital, Foshan, China
  18. 18. Department of Surgery of Cerebrovascular Diseases, Foshan First People’s Hospital, Foshan, China
  19. 19. Division of Neurosurgery, St. Michael’s Hospital, Toronto, ON, Canada
  20. 20. Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London, United Kingdom
  21. 21. Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
  22. 22. King’s Health Partners Academic Health Sciences Centre, London, United Kingdom
  23. 23. School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
  24. 24. The Neurosurgical Atlas, Carmel, IN, United States
  25. 25. Department of Neurological Surgery, Indiana University, Indianapolis, IN, United States
  26. 26. Neuro International Collaboration, Indianapolis, IN, United States

Source: Neurosurgical Review Published:2023


Abstract

Neurosurgical pathologies in pregnancy pose significant complications for the patient and fetus, and physiological stressors during anesthesia and surgery may lead to maternal and fetal complications. Awake craniotomy (AC) can preserve neurological functions while reducing exposure to anesthetic medications. We reviewed the literature investigating AC during pregnancy. PubMed, Scopus, and Web of Science databases were searched from the inception to February 7th, 2023, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Studies in English investigating AC in pregnant patients were included in the final analysis. Nine studies composed of nine pregnant patients and ten fetuses (one twin-gestating patient) were included. Glioma was the most common pathology reported in six (66.7%) patients. The frontal lobe was the most involved region (4 cases, 44.4%), followed by the frontoparietal region (2 cases, 22.2%). The awake-awake-awake approach was the most common protocol in seven (77.8%) studies. The shortest operation time was two hours, whereas the longest one was eight hours and 29 min. The mean gestational age at diagnosis was 13.6 ± 6.5 (2—22) and 19.6 ± 6.9 (9—30) weeks at craniotomy. Seven (77.8%) studies employed intraoperative fetal heart rate monitoring. None of the AC procedures was converted to general anesthesia. Ten healthy babies were delivered from patients who underwent AC. In experienced hands, AC for resection of cranial lesions of eloquent areas in pregnant patients is safe and feasible and does not alter the pregnancy outcome. © 2023, The Author(s).
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