SURG-09. AWAKE CRANIOTOMY FOR BRAIN TUMOR IN OCTOGENARIANS AND NONAGENARIANS
Bibliographic record
Abstract
Awake craniotomy allows for maximal tumor resection while improving survival and preserving functional status. This procedure is well tolerated in the elderly population (age 65–80). We report the Ottawa Hospital experience with patients 80 years old. A chart review (research ethics board approved) of awake craniotomies performed between July 2009 and February 2018 was completed. 14 patients 80 years old at the time of surgery were identified, with ages ranging from 80–93, averaging 83 ± 3.6 years old. Preoperatively, 12 patients had Karnofsky Performance Status (KPS) 80, 2 patients KPS 70. 8 tumors were frontal, 4 temporal, and 2 parietal. Average tumor volume was 23.9 ± 17.9 ml. Pathologies revealed 8 high grade gliomas, 4 metastatic lesions, 1 atypical meningioma and 1 case of radiation necrosis. Intraoperative functional mapping was successful in all the cases. Neuroanesthesiologists followed the protocol involving continuous infusion of low-ultra low dose of propofol, remifentanil and ketamine. Surgical time was 335 ± 84 min. Gross total resection was achieved in 8 patients; near total resection in 6 patients as confirmed by postoperative MRI. Ten patients (62%) had very good outcome with improvement or similar, as before surgery functional status at the time of discharge home, which averaged 4.7 ± 2 days post-operatively. Four patients (38%) had prolonged hospital stay of 37 ± 37 days post-operatively. Two of those patients had low KPS pre and post-operatively. The other two patients had transient increase in neurological deficit postoperatively requiring hospitalization. After initial improvement their functional status deteriorated post radiation therapy, which was started 1 month after surgery. There was no mortality over 30 days postoperatively. CONCLUSIONS: Octogenarians and nonagenarians tolerate surgery well following Ottawa Awake Craniotomy Protocol, especially when their preoperative functional status is good. Early good postoperative outcomes may be affected by their ensuing radiation therapy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".