A pilot comparative study of intraoperative results and surgical outcomes between asleep-awake-asleep and general anesthesia modalities in temporal lobe resections

To compare intraoperative findings and surgical outcomes in temporal lobe resections in patients with mesial temporal sclerosis in the language dominant hemisphere performed under general (GA) versus asleep-awake-asleep (AAA) anesthesia modalities. Single-center retrospective case-control study involving 31 adults who had clinical/imaging/neurophysiology concordant evidence of mesial temporal lobe epilepsy in the language dominant hemisphere submitted to temporal lobe epilepsy surgery. GA was used in 20 patients and AAA in 11 patients. Presurgical characteristics of the patients, intraoperative hemodynamic and physiological findings or complications and postoperative outcomes including ILAE scale scores at least 1 year of follow-up were analyzed using descriptive statistics and independent t-tests, Fisher's exact test, and χ² tests to identify differences between the groups. During the surgery, there were no notable differences between the groups in terms of hemodynamic parameters, arterial blood gas measurements, or bleeding. However, the surgery length was longer in AAA group. Postoperative outcomes, including hospital stay duration, complication rates, and follow-up periods, were also comparable without significant differences. Neurological deficits were minimal in both groups, with no statistically significant differences between them. Most patients achieved positive results based on the ILAE classification in both groups, with most experiencing either no seizures or rare, non-disabling seizures. AAA showed comparable results to general anesthesia, with no intraoperative complications or postoperative negative outcomes. However, due to the limited sample size, further evidence is needed to confirm its benefits in epilepsy surgery involving eloquent areas over GA.