Surgical Outcome Following Awake Craniotomy for Eloquent Supratentorial Tumour- A Single Centre Experience

Background: Maximal resection improves survival in glioma patients, but tumours in eloquent areas risk neurological deficits. Awake craniotomy with intraoperative mapping enables safe tumour removal while preserving motor, language, and cognitive functions. This study evaluates functional and cognitive outcomes in patients undergoing this approach. Material and Methods: This retrospective single-centre study (study period 2021 to march 2025) included adult patients with gliomas situated in eloquent brain regions. All participants underwent awake craniotomy with maximal tumour resection guided by intraoperative cortico-subcortical mapping according to functional boundaries. “Asleep-awake-asleep anaesthesia” technique using combination of propofol and fentanyl was used in all patients with functional outcomes evaluated included neurological status, cognitive and language function, and work capacity. Oncological outcomes comprised extent of resection (EOR) and survival. Results: The series included 25 awake surgeries (12 low-grade gliomas, 5 grade III gliomas, 5 grade IV glioblastomas and 3 dermoid cyst). 10 patients had tumour located in left frontal lobe, 5 in left insular lobe, 6 in left temporal lobe, 3 in right premotor area an 1 in left post central gyrus. Preoperatively, 5 patients (20%) had focal neurological deficits, 10 patients 40%) exhibited neuropsychological disturbances, and 05 patients (20%) were unable to work. Maximal resection (>90%) was achieved in 10/12 low-grade gliomas (83%), 4/5 grade III gliomas (80%), 4/5 glioblastomas (80%) and 3/3 (100 %) dermoid cyst. Intraoperative stimulation induced seizures occurred in 2/25(8%) patients. Postoperatively, 02 patients (8%) experienced transient worsening of neurological and/or cognitive status which recovered gradually. At 6-month follow-up, 20 (80%) patients had excellent outcome and were symptom free .Survival outcomes correlated significantly with both tumour grade and extent of resection. Conclusion: Functional mapping during awake craniotomy enables aggressive glioma resection without compromising neurological or cognitive outcomes in tumours located in eloquent area. Temporary postoperative deficits typically improve with individualized rehabilitation, allowing patients to regain daily functioning. Achieving a greater extent of resection remains critical for improving survival