{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T22:36:52Z","timestamp":1788043012135,"version":"build-2784847793"},"reference-count":53,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2013,2]]},"abstract":"\n Object<\/jats:title>\n Awake craniotomy for removal of intraaxial tumors within or adjacent to eloquent brain regions is a well-established procedure. However, awake craniotomy failures have not been well characterized. In the present study, the authors aimed to analyze and assess the incidence and causes for failed awake craniotomy.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n The database of awake craniotomies performed at Tel Aviv Medical Center between 2003 and 2010 was reviewed. Awake craniotomy was considered a failure if conversion to general anesthesia was required, or if adequate mapping or monitoring could not have been achieved.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of 488 patients undergoing awake craniotomy, 424 were identified as having complete medical, operative, and anesthesiology records. The awake craniotomies performed in 27 (6.4%) of these 424 patients were considered failures. The main causes of failure were lack of intraoperative communication with the patient (n = 18 [4.2%]) and\/or intraoperative seizures (n = 9 [2.1%]). Preoperative mixed dysphasia (p < 0.001) and treatment with phenytoin (p = 0.0019) were related to failure due to lack of communication. History of seizures (p = 0.03) and treatment with multiple antiepileptic drugs (p = 0.0012) were found to be related to failure due to intraoperative seizures. Compared with the successful awake craniotomy group, a significantly lower rate of gross-total resection was achieved (83% vs 54%, p = 0.008), there was a higher incidence of short-term speech deterioration postoperatively (6.1% vs 23.5%, p = 0.0017) as well as at 3 months postoperatively (2.3% vs 15.4%, p = 0.0002), and the hospitalization period was longer (4.9 \u00b1 6.2 days vs 8.0 \u00b1 10.1 days, p < 0.001). Significantly more major complications occurred in the failure group (4 [14.8%] of 27) than in the successful group (16 [4%] of 397) (p = 0.037).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Failures of awake craniotomy were associated with a lower incidence of gross-total resection and increased postoperative morbidity. The majority of awake craniotomy failures were preventable by adequate patient selection and avoiding side effects of drugs administered during surgery.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2012.10.jns12511","type":"journal-article","created":{"date-parts":[[2012,11,2]],"date-time":"2012-11-02T10:00:46Z","timestamp":1351850446000},"page":"243-249","source":"Crossref","is-referenced-by-count":165,"title":["Failed awake craniotomy: a retrospective analysis in 424 patients undergoing craniotomy for brain tumor"],"prefix":"10.3171","volume":"118","author":[{"given":"Erez","family":"Nossek","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Idit","family":"Matot","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care, Tel Aviv Medical Center, and"},{"name":"Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tal","family":"Shahar","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ori","family":"Barzilai","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoni","family":"Rapoport","sequence":"additional","affiliation":[{"name":"Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tal","family":"Gonen","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gal","family":"Sela","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akiva","family":"Korn","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Hayat","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care, Tel Aviv Medical Center, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zvi","family":"Ram","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns12511","series-title":"Can J Anaesth","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1007\/BF03019383","article-title":"Venous air embolism during awake craniotomy in a supine patient","volume":"50","author":"Balki","year":"2003"},{"key":"b2-jns12511","series-title":"Manual for the Beck Depression Inventory-II","author":"Beck","year":"1996"},{"key":"b3-jns12511","series-title":"Stereotact Funct Neurosurg","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1159\/000098989","article-title":"Intraoperative brain mapping techniques in neuro-oncology","volume":"58","author":"Berger","year":"1992"},{"key":"b4-jns12511","series-title":"J Neurosurg Anesthesiol","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1097\/00008506-200107000-00013","article-title":"Monitored anesthesia care using remifentanil and propofol for awake craniotomy","volume":"13","author":"Berkenstadt","year":"2001"},{"key":"b5-jns12511","series-title":"Curr Opin Anaesthesiol","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1097\/ACO.0b013e3283302339","article-title":"\u2018Anesthesia\u2019 for awake neurosurgery","volume":"22","author":"Bilotta","year":"2009"},{"key":"b6-jns12511","series-title":"Anesth Analg","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1097\/00000539-200101000-00018","article-title":"Awake craniotomy for removal of intracranial tumor: considerations for early discharge","volume":"92","author":"Blanshard","year":"2001"},{"key":"b7-jns12511","series-title":"Eur J Anaesthesiol","doi-asserted-by":"publisher","first-page":"906","DOI":"10.1097\/EJA.0b013e32833000c5","article-title":"Awake craniotomy","volume":"26","author":"Bonhomme","year":"2009"},{"issue":"4","key":"b8-jns12511","series-title":"Neurosurg Focus","first-page":"e5","article-title":"Improvements in brain tumor surgery: the modern history of awake craniotomies","volume":"18","author":"Bulsara","year":"2005"},{"key":"b9-jns12511","series-title":"Minim Invasive Neurosurg","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1055\/s-2008-1073132","article-title":"Day surgery awake craniotomy for removing brain tumours: technical note describing a simple protocol","volume":"51","author":"Carrabba","year":"2008"},{"key":"b10-jns12511","series-title":"Minerva Anestesiol","first-page":"289","article-title":"Awake neurosurgery: an update","volume":"74","author":"Conte","year":"2008"},{"key":"b11-jns12511","series-title":"J Neurosurg Anesthesiol","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1097\/ANA.0b013e3181c959f4","article-title":"Analysis of propofol\/remifentanil infusion protocol for tumor surgery with intraoperative brain mapping","volume":"22","author":"Conte","year":"2010"},{"key":"b12-jns12511","series-title":"Clin Neuropsychol","first-page":"3","article-title":"Translations of excerpts from Andr\u00e9 Rey's \u201cPsychological examination of traumatic encephalopathy\u201d and P.A. Osterrieth's \u201cThe complex figure copy test","volume":"7","author":"Corwin","year":"1939"},{"key":"b13-jns12511","series-title":"Neurocrit Care","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1385\/NCC:3:2:161","article-title":"Phenytoin poisoning","volume":"3","author":"Craig","year":"2005"},{"key":"b14-jns12511","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1097\/00006123-199801000-00006","article-title":"Patient tolerance of craniotomy performed with the patient under local anesthesia and monitored conscious sedation","volume":"42","author":"Danks","year":"1998"},{"key":"b15-jns12511","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1074","DOI":"10.1227\/01.NEU.0000369514.74284.78","article-title":"Awake mapping optimizes the extent of resection for low-grade gliomas in eloquent areas","volume":"66","author":"De Benedictis","year":"2010"},{"key":"b16-jns12511","series-title":"Clin Neurol Neurosurg","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1016\/j.clineuro.2007.01.008","article-title":"Awake craniotomy versus surgery under general anesthesia for resection of intrinsic lesions of eloquent cortex\u2014a prospective randomised study","volume":"109","author":"Gupta","year":"2007"},{"key":"b17-jns12511","series-title":"Neurol India","doi-asserted-by":"publisher","first-page":"66","DOI":"10.4103\/0028-3886.76862","article-title":"Phenytoin toxicity presenting as acute meningo-encephalitis in children","volume":"59","author":"Gupta","year":"2011"},{"key":"b18-jns12511","series-title":"J Clin Exp Neuropsychol","doi-asserted-by":"publisher","first-page":"690","DOI":"10.1080\/13803390490918499","article-title":"Phonemic fluency, semantic fluency, and difference scores: normative data for adult Hebrew speakers","volume":"27","author":"Kav\u00e9","year":"2005"},{"key":"b19-jns12511","series-title":"Brain Lang","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1016\/j.bandl.2004.06.004","article-title":"Standardization and norms for a Hebrew naming test","volume":"92","author":"Kav\u00e9","year":"2005"},{"key":"b20-jns12511","series-title":"Anesth Analg","doi-asserted-by":"publisher","first-page":"502","DOI":"10.1213\/01.ANE.0000160533.51420.44","article-title":"A retrospective analysis of a remifentanil\/propofol general anesthetic for craniotomy before awake functional brain mapping","volume":"101","author":"Keifer","year":"2005"},{"key":"b21-jns12511","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1056","DOI":"10.3171\/2009.6.JNS09716","article-title":"Patients' perceptions of awake and outpatient craniotomy for brain tumor: a qualitative study. Clinical article","volume":"112","author":"Khu","year":"2010"},{"key":"b22-jns12511","series-title":"J Clin Neurosci","doi-asserted-by":"publisher","first-page":"886","DOI":"10.1016\/j.jocn.2008.10.002","article-title":"Intraoperative swelling leading to neurological deterioration: an argument for large craniotomy in awake surgery for glioma resection","volume":"16","author":"Khu","year":"2009"},{"key":"b23-jns12511","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"836","DOI":"10.1227\/01.NEU.0000342405.80881.81","article-title":"Awake craniotomy for brain tumors near eloquent cortex: correlation of intraoperative cortical mapping with neurological outcomes in 309 consecutive patients","volume":"64","author":"Kim","year":"2009"},{"key":"b24-jns12511","series-title":"Med Toxicol","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1007\/BF03259910","article-title":"Clinical features and management of poisoning due to phenytoin","volume":"4","author":"Larsen","year":"1989"},{"key":"b25-jns12511","series-title":"J Clin Anesth","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1016\/S0952-8180(02)00354-9","article-title":"Postoperative nausea and vomiting after craniotomy for tumor surgery: a comparison between awake craniotomy and general anesthesia","volume":"14","author":"Manninen","year":"2002"},{"key":"b26-jns12511","series-title":"Eur J Paediatr Neurol","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1016\/j.ejpn.2010.05.008","article-title":"Phenytoin-induced visual disturbances mimicking delirium tremens in a child","volume":"14","author":"Mar\u00edn","year":"2010"},{"key":"b27-jns12511","series-title":"Br J Anaesth","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1093\/bja\/aeq015","article-title":"Laryngeal mask airway Supreme for asleep-awake-asleep craniotomy","volume":"104","author":"Murata","year":"2010"},{"key":"b28-jns12511","series-title":"South Med J","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1097\/00007611-199110000-00010","article-title":"Phenytoin intoxication","volume":"84","author":"Murphy","year":"1991"},{"key":"b29-jns12511","series-title":"J Am Geriatr Soc","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1111\/j.1532-5415.2005.53221.x","article-title":"The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment","volume":"53","author":"Nasreddine","year":"2005"},{"key":"b30-jns12511","series-title":"Eur J Anaesthesiol","doi-asserted-by":"publisher","first-page":"662","DOI":"10.1017\/S0265021508003633","article-title":"The asleep-awake technique using propofol-remifentanil anaesthesia for awake craniotomy for cerebral tumours","volume":"25","author":"Olsen","year":"2008"},{"key":"b31-jns12511","series-title":"Cancer Nurs","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1097\/01.NCC.0000305699.97625.dc","article-title":"The experience of patients undergoing awake craniotomy: in the patients' own words. A qualitative study","volume":"31","author":"Palese","year":"2008"},{"key":"b32-jns12511","series-title":"J Clin Psychol","doi-asserted-by":"publisher","first-page":"768","DOI":"10.1002\/1097-4679(199511)51:6<768::AID-JCLP2270510607>3.0.CO;2-1","article-title":"Factor structure of the Barratt impulsiveness scale","volume":"51","author":"Patton","year":"1995"},{"key":"b33-jns12511","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"1215","DOI":"10.1007\/s00701-009-0363-9","article-title":"Outcome of fully awake craniotomy for lesions near the eloquent cortex: analysis of a prospective surgical series of 79 supratentorial primary brain tumors with long follow-up","volume":"151","author":"Pereira","year":"2009"},{"key":"b34-jns12511","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"633","DOI":"10.3171\/2010.5.JNS1041","article-title":"A retrospective cohort-matched comparison of conscious sedation versus general anesthesia for supratentorial glioma resection. Clinical article","volume":"114","author":"Peruzzi","year":"2011"},{"key":"b35-jns12511","series-title":"Minerva Anestesiol","first-page":"393","article-title":"Management of anesthesia in awake craniotomy","volume":"74","author":"Piccioni","year":"2008"},{"key":"b36-jns12511","series-title":"Clin Neurol Neurosurg","doi-asserted-by":"publisher","first-page":"1064","DOI":"10.1016\/j.clineuro.2008.07.005","article-title":"Avoidance and management of trigeminocardiac reflex complicating awake-craniotomy","volume":"110","author":"Prabhu","year":"2008"},{"key":"b37-jns12511","series-title":"L'Examen Clinique en Psychologia","author":"Rey","year":"1964"},{"key":"b38-jns12511","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1192","DOI":"10.1227\/NEU.0b013e31820c02a3","article-title":"Awake craniotomy vs surgery under general anesthesia for resection of supratentorial lesions","volume":"68","author":"Sacko","year":"2011"},{"key":"b39-jns12511","series-title":"Neurotherapeutics","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1016\/j.nurt.2009.04.005","article-title":"Operative techniques for gliomas and the value of extent of resection","volume":"6","author":"Sanai","year":"2009"},{"key":"b40-jns12511","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"349","DOI":"10.3171\/jns.1998.88.2.0349","article-title":"Rapid termination of intraoperative stimulation-evoked seizures with application of cold Ringer's lactate to the cortex. Technical note","volume":"88","author":"Sartorius","year":"1998"},{"key":"b41-jns12511","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1016\/S0090-3019(96)00340-0","article-title":"Intraoperative brain mapping in a community setting\u2014technical considerations","volume":"47","author":"Sartorius","year":"1997"},{"key":"b42-jns12511","series-title":"Anaesthesist","first-page":"585","article-title":"[\u201cAsleep-awake-asleep\u201d-anaesthetic technique for awake craniotomy","volume":"55","author":"Schulz","year":"2006"},{"key":"b43-jns12511","series-title":"Anaesthesia","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1111\/j.1365-2044.1995.tb04611.x","article-title":"Air embolism during awake craniotomy","volume":"50","author":"Scuplak","year":"1995"},{"key":"b44-jns12511","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3171\/JNS-07\/07\/0001","article-title":"Prospective study of awake craniotomy used routinely and nonselectively for supratentorial tumors","volume":"107","author":"Serletis","year":"2007"},{"key":"b45-jns12511","series-title":"Manual for the State-Trait Anxiety Inventor","author":"Spielberger","year":"1970"},{"key":"b46-jns12511","series-title":"J Exp Psychol","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1037\/h0054651","article-title":"Studies of interference in serial verbal reactions","volume":"18","author":"Stroop","year":"1935"},{"issue":"2","key":"b47-jns12511","series-title":"Neurosurg Focus","doi-asserted-by":"publisher","first-page":"E7","DOI":"10.3171\/2009.12.FOCUS09237","article-title":"Intraoperative electrical stimulation in awake craniotomy: methodological aspects of current practice","volume":"28","author":"Szel\u00e9nyi","year":"2010"},{"key":"b48-jns12511","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"35","DOI":"10.3171\/jns.1999.90.1.0035","article-title":"Awake craniotomy with brain mapping as the routine surgical approach to treating patients with supratentorial intraaxial tumors: a prospective trial of 200 cases","volume":"90","author":"Taylor","year":"1999"},{"key":"b49-jns12511","series-title":"Acta Neurol Belg","first-page":"218","article-title":"Acute visual dysfunction following phenytoin-induced toxicity","volume":"103","author":"Thakral","year":"2003"},{"key":"b50-jns12511","series-title":"Pers Individ Dif","doi-asserted-by":"publisher","first-page":"837","DOI":"10.1016\/S0191-8869(00)00183-5","article-title":"The sensitivity to punishment and sensitivity to reward questionnaire (SPSRQ) as a measure of Gray's anxiety and impulsivity dimensions","volume":"31","author":"Torrubia","year":"2001"},{"key":"b51-jns12511","series-title":"The Measurement of Adult Intelligence","author":"Wechsler","year":"1939"},{"key":"b52-jns12511","series-title":"J Psychol","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1080\/00223980.1945.9917223","article-title":"A standardized memory scale for clinical use","volume":"19","author":"Wechsler","year":"1945"},{"key":"b53-jns12511","series-title":"AANA J","first-page":"29","article-title":"Nonopioid anesthesia for awake craniotomy: a case report","volume":"78","author":"Wolff","year":"2010"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/118\/2\/article-p243.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/118\/2\/article-p243.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/118\/2\/article-p243.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,14]],"date-time":"2022-08-14T13:58:42Z","timestamp":1660485522000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/118\/2\/article-p243.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2013,2]]},"references-count":53,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2012.10.jns12511","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.718056144.793481450","asserted-by":"object"}]},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,2]]}}}