[Awake surgery for brain gliomas: plea for an increased involvement of anesthesiologists]

The recent development of awake surgery in neuro-oncology allowed a conceptual change, i.e. the realization of resection for invasive brain tumors according to functional and not anatomic boundaries. This paradigmatic shift enabled a significant improvement of results in surgery for gliomas, by opening the door to resections within eloquent areas classically considered as "inoperable", while preserving and even improving the quality of life of patients. In addition, the extent of resections has been maximized, leading to an increase of median survival - especially in low-grade gliomas. Strong relationships between the different teams (surgeons, neuropsychologists, anaesthesiologists) are crucial for the development and improvement of awake surgery. Thus, it seems important that anesthesiologists can benefit from a clear and accurate knowledge of the real contribution of this procedure, in order to better evaluate the balance between the theoretical risks of surgery under local anesthesia versus the actual risk of not performing resection with a maximum of safety and efficiency for the patients. The purpose of this plea is to advocate the spread of awake surgery in routine practice, due to its major impact on both functional and survival outcomes, by nonetheless keeping in mind that a multidisciplinary staff is mandatory for selection of patients as well as into the operating room. In this state of mind, anaesthesiologists have to play a central role, through an increased involvement in this field.