Surgical history and temporal muscle thickness as predictors of successful awake surgery in older patients with glioma

Awake surgery is considered a favorable option; however, for older patients, the evidence remains inconsistent, with some studies reporting higher intraoperative risks and others questioning its safety and efficacy. We investigated the factors that are associated with intraoperative failure and developed a model for predicting the success of awake surgery in older adults with gliomas. We retrospectively analyzed data from 40 patients aged ≥ 65 years with glioma who underwent awake surgery at our hospital. Based on whether awake monitoring was completed as planned, patients were classified into “successful” and “unsuccessful” groups. To identify the predictors of successful surgery, we performed stepwise multiple logistic regression, receiver operating characteristic (ROC) curve analysis, and estimated predicted probabilities using the final model. Awake surgery was successfully completed in 65% of patients and not completed in 35%. Two variables significantly influenced feasibility: preoperative temporal muscle thickness (TMT), reflecting general health (p = 0.013), and surgical history (p = 0.0093). ROC analysis identified thresholds of TMT ≥ 5.0 mm and undergoing first-time surgery. The proportion of patients achieving a KPS score ≥ 80% at 3, 6, and 12 months postoperatively was significantly higher in the successful group (p = 0.0093, p = 0.0039, and p = 0.0055), whereas no preoperative difference was observed. Successful awake surgery in older patients may help maintain functional independence in the chronic phase. A preoperative TMT ≥ 5.0 mm and first-time surgery may serve as practical criteria for selecting older patients most likely to benefit from awake procedures.