Quality of Recovery Awake Versus Asleep Craniotomy

Awake craniotomy (AC) is an anesthetic and surgical technique commonly used to resect tumors
involving or adjacent to the eloquent or motor cortices, those portions of the brain that are
responsible for language and motor skills, respectively. By mapping those areas of the brain
that are necessary for such functions, the neurosurgeon is able to avoid resection of
cortical tissue that might compromise the patient's abilities to speak or move, hence
preserving neurologic function. AC is often accomplished by direct cortical stimulation or
inhibition, while maintaining the patient's ability to interact with the operative team. The
anesthetic technique often involves a regional (scalp) block combined with intraoperative
intravenous mild sedation. In some reported instances of AC, no cortical mapping is
performed, and the technique is performed solely because it is thought that AC leads to a
better recovery profile (less pain, better neurologic outcome, and shorter hospital stay)
than craniotomy performed under general anesthesia.

The Quality of Recovery Score (QoR-40) is a validated, multi-parameter instrument that has
been used in various postoperative populations to assess the overall satisfaction and
well-being of patients having undergone anesthesia and surgery. Leslie et al. have reported
that the QoR-40 is a valid tool in assessing neurosurgical patients, but a direct comparison
between AC patients and general anesthesia craniotomy (GAC) patients using this tool has
never been performed.

AC may also be associated with better 30 and 90 day multi-parameter outcomes than GAC. The
well-validated Acute Short Form (SF-12) health survey, an abbreviated version of the SF-36,
consists of 12 items. It measures two domains, including mental and physical component
summaries (mental component summary and physical composite score, respectively).

Hypothesis:

Awake craniotomy for tumor resection is associated with a better multi-parameter quality of
recovery in the immediate postoperative period, and better 30 and 90 day quality of life
outcomes, than craniotomy performed under general anesthesia.