Awake Craniotomy Techniques in Brain Tumor Surgery
Summary
Awake craniotomy is a refined neurosurgical approach for resecting intracranial neoplasms situated within or adjacent to functionally critical brain regions. By maintaining patient consciousness during key operative stages, surgeons can employ real-time functional mapping to identify and preserve cortical and subcortical pathways governing language, motor and sensory functions. This technique balances maximising tumour removal with minimising postoperative deficits. Protocols vary in anaesthetic management, ranging from monitored sedation to staged asleep–awake–asleep regimes, each tailored to optimise patient comfort, cooperation and safety. Intraoperative stimulation mapping further guides resection boundaries, reducing the risk of permanent neurological impairment. Recent advancements include standardised frameworks for grading postoperative deficits, integration of neuropsychological assessment, and adaptation of protocols for resource-limited settings. As awake craniotomy gains acceptance worldwide, efforts to harmonise techniques and outcomes are increasingly significant for improving global neurosurgical care.
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Awake Craniotomy Techniques in Brain Tumor Surgery publication trend
The graph below shows the total number of articles in awake craniotomy techniques in brain tumor surgery across all publications each year (not limited to Nature Index journals).
Technical terms
Awake craniotomy: A neurosurgical procedure during which the patient remains conscious to enable intraoperative assessment of neurological function and direct mapping of critical brain regions.
Intraoperative stimulation mapping: The use of electrical stimulation to identify and delineate functional cortical and subcortical areas in real time during surgery.
Eloquent cortex: Regions of the cerebral cortex responsible for essential functions such as language, motor control and sensory processing.
Gross total resection (GTR): The surgical removal of all visibly detectable tumour tissue as assessed by the operating surgeon and confirmed on postoperative imaging.
Extent of resection (EOR): A quantitative measure of the proportion of tumour mass removed during surgery, often expressed as a percentage of preoperative tumour volume.
References
- Level I and II deficits—A clinical survey on international practice of awake craniotomy and definitions of postoperative “major” and “minor” deficits. Neuro-Oncology Advances (2024).
- Awake Craniotomy in Africa: A Scoping Review of Literature and Proposed Solutions to Tackle Challenges. Neurosurgery (2023).
- Awake craniotomy for resection of supratentorial glioblastoma: a systematic review and meta-analysis. Neuro-Oncology Advances (2020).
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