P07.05.A AWAKE CRANIOTOMY FOR ELOQUENT GLIOMA: A SINGLE CENTER COHORT REVIEW

Abstract BACKGROUND Supratotal oncologic resection, extending beyond visible MRI boundaries, has been shown to slow and prevent malignant progression of gliomas. Despite its benefits, supratotal resection near eloquent areas poses increased risks of postoperative neurological dysfunction. This study aims to present a review of 11 years of awake craniotomies for oncological resection at a Quebec center, comparing resection rates and complication rates with current literature. MATERIAL AND METHODS This retrospective descriptive study includes patients who underwent awake craniotomies for oncologic resection at a Quebec tertiary neurosurgical center between January 2011 and December 2022. Awake craniotomy was indicated for lesions near language eloquent areas with reasonable risks of language deterioration. The surgical plan aimed for supramaximal function-limited safe resection whenever possible. The procedure followed a sleep-awake-sleep strategy. Patients were assessed immediately postoperatively, daily during hospitalization, at 2 weeks post-op with pathology results, and at 3 months post-op. Follow-up continued based on pathology. Data on demographics, pre-op KPS score, length of surgery, time awake, length of hospital stay, cause of possible resection limitation, perioperative complications, and postoperative complications were collected. The extent of resection was assessed using tumor volumetry differences between pre-op and post-op MRI. RESULTS 77 patients underwent awake craniotomy, with 38% female and a mean age of 48 years. The mean pre-op KPS was 93. Diagnoses included various grades of astrocytomas, oligodendrogliomas, glioblastomas, and other pathologies. Perioperative complications included loss of patient cooperation, significant headaches, nausea, agitation, convulsions, and significant bleeding. Resection was limited by reached neurologic functions in 60% of cases. Early postoperative complications occurred in 48% of patients, with 34% experiencing early language deteriorations. Late complications occurred in 13% of patients, with 6% involving language. The mean extent of resection (EOR) was 86.71%. CONCLUSION Despite high early postoperative language deterioration rates, low rate of late language complications suggests that aiming for supramaximal function-limited safe resection permits high EOR with low late language complication rates. Our center results are concordant with current literature, further supporting the use of awake craniotomy as a valuable approach for maximizing safe resections near eloquent cortex areas in oncologic settings.