BACKGROUND AND OBJECTIVE

Awake craniotomy is often used in the surgery of glioma, the most common primary brain tumor. It has been proven to maximize the extent of tumor resection while minimizing post-operative neurologic deficits. Extensive research has been conducted on this topic, and we would like to perform a bibliometric analysis to identify the top 100 most cited articles in awake glioma surgery. Knowing the relevant and most impactful studies in the field would help clinicians streamline the evidence and determine its application in their practice.

METHODS

In October 2023, we performed a title-specific search on the Scopus and PubMed databases using (“glioma*” OR “astrocytoma*” OR “glioblastoma” OR “low grade glioma” OR “high grade glioma”) and (“awake craniotomy” OR “awake surgery” OR “awake brain surgery” OR “awake neurosurgery”) as our query term without any restriction criteria. The top 100 most cited articles were identified, reviewed, and analyzed.

RESULTS

Our search yielded a total of 5557 articles published. The top article had a citation count of 834 and reported on functional outcome after language mapping in glioma resection. Journal of Neurosurgery had the most number of publications. Neurosurgeons (n=81) were the primary author in most publications, followed by anesthesiologists (n=22) and neurologists (n=6). Three countries (USA, France, Italy) contributed to 74% of the articles. Most of the articles were reviews and case reports/series.

CONCLUSION

This study identified the top 100 most cited articles on awake glioma surgery. The content dealt with several aspects of awake craniotomy such as brain mapping, intraoperative techniques and adjuncts, and practice recommendations. This analysis can help identify knowledge gaps and potential areas of research in glioma surgery.

Glioma ; Glioblastoma ; Astrocytoma ; Bibliometric Analysis ; Bibliometrics

BACKGROUND

Pituitary adenomas comprise approximately 20% of surgically resected intracranial tumors. This study aimed to collect local data on the post-operative neurologic, visual and endocrine outcomes of patients with pituitary macroadenoma.

METHODOLOGY

This is a retrospective study of patients with pituitary macroadenoma who underwent neurosurgery at the Philippine General Hospital between 2017 to 2022. Data on demographics, clinical signs and symptoms, neuro-ophthalmologic examination findings, hormonal and radiologic studies, type of surgery, and post-operative outcomes were collected. Statistical analyses were done to compare the neurologic, ophthalmologic and endocrine status pre- and post-operatively.

RESULTS

A total of 122 patients were included. The mean age was 44.18 years, and majority (50.82%) were female. The most common presentation was blurring of vision. Most tumors were non-functioning (77.87%). Among the functioning adenomas, the most common was acromegaly. The median tumor size was 3.5 cm, and the median time to surgery was 18 months. Microscopic transsphenoidal surgery was the most common approach (60.83%) followed by endoscopic resection (24.17%). There was significant improvement in visual acuity post-operatively (p >0.05), by approximately one line in the Snellen chart. There was also some improvement in post-operative endocrine function, manifested as a significant decrease in the use of hormone replacement therapy. Factors such as age, sex, type of adenoma, tumor size, timing of surgery, surgical approach, post-operative complications and adjuvant radiation were not significantly associated with the visual and endocrine outcomes (p >0.005).

CONCLUSION

This is the first local study to comprehensively assess the entirety of post-operative outcomes among pituitary macroadenoma patients. Our results showed that even patients with longstanding visual and endocrine deficits may still improve with surgery.

Philippines