• Yang Yuan, Zhou Peizhi, Wang Xiang, Liu Yanhui, Liang Ruofei, Jiang Shu, and Mao Qing.
• Department of Neurosurgery, West China Hospital, Si Chuan University, Chengdu, China.
• J Neurosurg Sci. 2019 Jun 1; 63 (3): 301-307.

IntroductionAwake craniotomies (AC) could reduce neurological deficits compared with patients under general anesthesia, however, intraoperative seizure (IOS) is a major reason causing awake surgery failure. The purpose of the study was to give a comprehensive overview the published articles focused on seizure incidence in AC.Evidence AcquisitionBibliographic searches of the Embase, Medline, were performed to identify articles and conference abstracts that investigated the IOS frequency of patients underwent AC.Evidence SynthesisTwenty-five studies were included in this meta-analysis. Among the 25 included studies, one was randomized controlled trials and 5 of them were comparable studies. The pooled data suggested the general IOS rate for patients with AC was 8% (fixed effect model), sub-group analysis identified IOS rate for glioma patients was 8% and low grade patients was 10%. The pooled data showed early seizure rates of AC patients was 11% and late seizure rates was 35%.ConclusionsThis systematic review and meta-analysis shows that AC is a safe technique with relatively low IOS occurrence. However, few RCTs were available, and the acquisition of further evidence through high-quality RCTs is highly recommended.

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