The Safety and Usefulness of Awake Surgery as a Treatment Modality for Glioblastoma: A Retrospective Cohort Study and Literature Review.

Simple Summary: Awake surgery is the gold standard for localizing brain function and contributes to the maximal safe resection of brain tumors. On the other hand, the effectiveness of awake surgery for glioblastomas is controversial. One reason is that it is unclear whether awake surgery can be performed safely and whether functional areas can be detected in glioblastomas, which cause more severe edema than lower-grade gliomas. The purpose of this study was to examine the efficacy and safety of awake surgery for glioblastomas and to determine its current status through a literature review. Our study revealed awake mapping was successfully completed in 88%, and a positive response to mapping was observed in 53% of participants. The extent of resection and neurological deficits were comparable to previous studies. We concluded that awake surgery for glioblastomas can be safely performed and is useful for detecting functional areas. These findings influence treatment strategies for glioblastomas and improve treatment outcomes. Awake surgery contributes to the maximal safe removal of gliomas by localizing brain function. However, the efficacy and safety thereof as a treatment modality for glioblastomas (GBMs) have not yet been established. In this study, we analyzed the outcomes of awake surgery as a treatment modality for GBMs, response to awake mapping, and the factors correlated with mapping failure. Patients with GBMs who had undergone awake surgery at our hospital between March 2010 and February 2023 were included in this study. Those with recurrence were excluded from this study. The clinical characteristics, response to awake mapping, extent of resection (EOR), postoperative complications, progression-free survival (PFS), overall survival (OS), and factors correlated with mapping failure were retrospectively analyzed. Of the 32 participants included in this study, the median age was 57 years old; 17 (53%) were male. Awake mapping was successfully completed in 28 participants (88%). A positive response to mapping and limited resection were observed in 17 (53%) and 13 participants (41%), respectively. The EOR included gross total, subtotal, and partial resections and biopsies in 19 (59%), 8 (25%), 3 (9%), and 2 cases (6%), respectively. Eight (25%) and three participants (9%) presented with neurological deterioration in the acute postoperative period and at 3 months postoperatively, respectively. The median PFS and OS were 15.7 and 36.9 months, respectively. The time from anesthetic induction to extubation was statistically significantly longer in the mapping failure cohort than that in the mapping success cohort. Functional areas could be detected during awake surgery in participants with GBMs. Thus, awake mapping influences intraoperative discernment, contributes to the preservation of brain function, and improves treatment outcomes. [ABSTRACT FROM AUTHOR]