Outcomes of awake surgery for recurrent glioblastoma: A single-institution retrospective analysis

Awake surgery facilitates maximal safe resection of brain tissue in cases of glioma, but its effectiveness for recurrent glioblastoma (GBM) remains unestablished. In this study, we investigate the safety, success rate of mapping, and surgical outcomes of awake surgery for recurrent GBM.

This study included glioma cases that underwent awake surgery at our hospital between March 2010 and February 2023 and met the following criteria: (1) cases with a pathologic diagnosis of glioblastoma or astrocytoma, isocitrate dehydrogenase-mutant, WHO grade 4 at recurrence, and (2) cases in which this was the second surgery in the course of treatment. We retrospectively analyzed the clinical features, mapping response, resection rate, postoperative complications, overall survival (OS), and progression-free survival (PFS).

Forty-one cases were analyzed. The median age was 47 years, and 24 patients (58.5 %) were male. Awake mapping was successfully completed in 35 cases (85.4 %). A positive response to mapping was observed in 20 cases (48.8 %), which limited resection in 15 cases (36.6 %). The extent of resection was gross total resection in 20 cases (48.8 %), subtotal resection in 11 cases (26.8 %), partial resection in 8 cases (19.5 %), and biopsy in 2 cases (4.9 %). Acute-phase neurological deficits developed in 10 cases (24.4 %), but sequelae or symptom exacerbations were observed in 2 cases (4.9 %). The median post-recurrence OS and PFS were 18.7 months and 7.2 months, respectively.

Awake mapping for recurrent GBM demonstrated a low complication rate and facilitated tumor resection without exacerbating neurological symptoms. Awake surgery for recurrent GBM may contribute to prolonged survival.