Awake Craniotomy for Diffuse Low Grade Gliomas in a Resource Limited Setting: Lessons Learned with a Consecutive...

Despite the benefits of awake craniotomy (AC), many centers do not provide access to this service. We demonstrated the oncological and functional results of our initial experience in implementing AC in a context of resource-limited setting.

This prospective, observational, descriptive study collected the first 51 ACs for diffuse low grade glioma, classified according to the 2016 WHO classification.

Patient mean age was 35.9 ± 9.9 years-old. The most common clinical presentation was seizure (89.6%). Average segmented volume was 69.8 cc, and the largest diameter for 51% of lesions was more than 6 cm. Resection of more than 90% of the lesion was achieved in 49% of cases, and greater than 80% in 66.6% of cases. The mean follow-up was 835 days (2.29 years). Satisfactory Karnofsky performance status (KPS) (80 to 100) was observed in 90.1% pre-surgery, 50.9% at 5 days, 93.7% at 3 months, and 89.7% at 1-year post-op. In the multivariate analysis, tumor volume, new postoperative deficit, and the extent of resection were related to KPS at 1 year of follow-up.

Functional decline was clearly observed in the immediate postoperative period, but excellent recovery of functional status was observed in the medium and long term. The data presented indicate the benefits of this mapping in both cerebral hemispheres, addressing several cognitive functions in addition to motricity and language. The proposed AC model is a reproducible, resource-saving technique, that can be performed safely, with good functional outcomes.