J Neurol Surg A Cent Eur Neurosurg 2017; 78(04): 368-373
DOI: 10.1055/s-0036-1586252
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Operative Strategies during Awake Surgery Affect Deterioration of Paresis a Month after Surgery for Brain Lesions in the Primary Motor Area

Nobusada Shinoura
1   Department of Neurosurgery, Komagome Metropolitan Hospital, Tokyo, Japan
Akira Midorikawa
2   Department of Psychology, Chuo University of Literature, Tokyo, Japan
Ryoji Yamada
1   Department of Neurosurgery, Komagome Metropolitan Hospital, Tokyo, Japan
Kentaro Hiromitsu
2   Department of Psychology, Chuo University of Literature, Tokyo, Japan
Chihiro Itoi
2   Department of Psychology, Chuo University of Literature, Tokyo, Japan
Shoko Saito
2   Department of Psychology, Chuo University of Literature, Tokyo, Japan
Kazuo Yagi
3   Department of Radiologic Technology, Tokyo Metropolitan University of Health Sciences, Tokyo, Japan
› Author Affiliations
Further Information

Publication History

10 June 2015

27 May 2016

Publication Date:
18 October 2016 (online)


Introduction We analyzed factors associated with worsened paresis at 1-month follow-up in patients with brain tumors located in the primary motor area (M1) to establish protocols for safe awake craniotomy for M1 lesions.

Methods Patients with M1 brain tumors who underwent awake surgery in our hospital (n = 61) were evaluated before, during, and immediately and 1 month after surgery for severity of paresis, tumor location, extent of resection, complications, preoperative motor strength, histology, and operative strategies (surgery stopped or continued after deterioration of motor function).

Results Worsened paresis at 1-month follow-up was significantly associated with worsened paresis immediately after surgery and also with operative strategy. Specifically, when motor function deteriorated during awake surgery and did not recover within 5 to 10 minutes, no deterioration was observed at 1-month follow-up in cases where we stopped surgery, whereas 6 of 13 cases showed deteriorated motor function at 1-month follow-up in cases where we continued surgery.

Conclusion Stopping tumor resection on deterioration of motor function during awake surgery may help prevent worsened paresis at 1-month follow-up.

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