Awake Craniotomy Versus General Anesthesia for Resection of High-Grade Gliomas: A Systematic Review and Meta-Analysis

Area of Science:

• Neurosurgery
• Anesthesiology
• Oncology

Background:

• Optimal anesthetic management for high-grade glioma resection is debated.
• Awake craniotomy with brain mapping is compared to general anesthesia.

Purpose of the Study:

• To systematically review and meta-analyze survival and functional outcomes.
• Compare awake craniotomy versus general anesthesia for high-grade gliomas.

Main Methods:

• Systematic review and meta-analysis of comparative studies (2000-2025).
• Searched PubMed, Web of Science, Cochrane, Embase.
• Analyzed overall survival and neurological deficits using random-effects models.

Main Results:

• Awake craniotomy associated with improved overall survival (30% mortality risk reduction).
• Significantly reduced neurological deficits (13% vs. 21%) and hospital stay (41% reduction).
• Greater extent of resection achieved; benefits pronounced for eloquent area tumors.

Conclusions:

• Awake craniotomy may offer survival and functional advantages for selected high-grade glioma patients.
• Evidence certainty is limited by observational data and heterogeneity.
• Further randomized trials are needed to confirm benefits and address limitations.