Surgical outcome of awake craniotomy with intraoperative brain mapping for supratentorial gliomas near eloquent areas: a prospective observational cohort study

Abstract Background Awake craniotomy (AC) with intraoperative brain mapping is the preferred approach for maximising the extent of resection (EOR) in gliomas near eloquent cortex while preserving neurological function. Its feasibility and outcomes in an Egyptian university hospital setting have not been systematically reported. Methods A prospective observational cohort study enrolled 20 patients with supratentorial glial or glioneuronal tumours in or near eloquent cortex who underwent awake craniotomy with intraoperative cortical and subcortical mapping at Mansoura University Hospitals (December 2021–December 2023). Primary outcomes were EOR, intraoperative complications, and new neurological deficits. Karnofsky Performance Status (KPS) was assessed preoperatively and at 1, 3, and 6 months postoperatively. Results Positive cortical mapping sites were identified in 85% of patients. Mean EOR was 94.2% ± 9.2%, with gross total resection (GTR, EOR ≥ 95%) achieved in 70% ( n = 14). New early neurological deficits occurred in 55% of patients; only 10% ( n = 2) retained a residual deficit at 6 month follow-up. Mean KPS improved significantly from 82.5 ± 11.2 at baseline to 92.0 ± 11.5 at 6 months (paired t-test, p = 0.036). No perioperative mortality occurred. High patient satisfaction was reported by 77.8% of assessable patients. Conclusions Awake craniotomy with intraoperative brain mapping achieves high EOR, a low rate of persistent neurological deficit (10% at 6 months), and significant midterm functional improvement in eloquent-area glioma surgery. These results compare favourably with international series and support establishing awake mapping as a standard strategy in Egyptian neurosurgical centres.