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Related Experiment Video

Updated: May 28, 2026

Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
09:53

Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery

Published on: July 5, 2021

Two-step awake craniotomy for diffuse supratentorial gliomas.

Petra Bintintan-Socaciu1,2,3,4,5, Shuroq Taju1,2,3, Angela Elia1,2,3

  • 1Service de Neurochirurgie, GHU-Paris Psychiatrie et Neuro-sciences, Paris, France.

Neuro-Oncology Advances
|May 27, 2026
PubMed
Summary

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This summary is machine-generated.

A two-step awake craniotomy is a safe and effective strategy for diffuse gliomas when initial surgeries are interrupted. This approach allows for maximal safe resection, particularly in patients with attention deficits or specific tumor locations.

Area of Science:

  • Neurosurgery
  • Oncology
  • Neuroscience

Background:

  • Maximal safe resection is standard for diffuse gliomas, balancing tumor removal with functional preservation.
  • Neurocognitive testing can limit resection completion due to progressive accuracy loss.
  • The 2-step awake craniotomy approach was assessed for prevalence, feasibility, safety, and efficacy.

Purpose of the Study:

  • To evaluate the effectiveness and safety of a 2-step awake craniotomy for diffuse gliomas.
  • To identify predictors for requiring a second awake procedure to achieve maximal function-based resection.
  • To determine the additional resection rate and impact on complete resection in 2-step procedures.

Main Methods:

  • Retrospective single-center cohort study of 449 supratentorial diffuse glioma awake craniotomies (2009-2024).
Keywords:
awake craniotomybrain mappinggliomaneurocognitive functionsurgical staging

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  • Collection of clinical, neurocognitive, imaging, oncological, and intraoperative data.
  • Analysis of factors leading to premature interruption of the first awake procedure.

    • Main Results:

    • 12 (2.8%) of 449 awake craniotomies required a second procedure, often due to neurocognitive decline or patient fatigue.
    • The second procedure demonstrated no increased intraoperative adverse events and achieved a median additional 32.3% resection.
    • Complete resection rates increased from 0/12 to 6/12 in patients undergoing the 2-step approach.
    • Preoperative attention impairment, left-hemispheric location, and insular involvement predicted the need for a 2-step procedure.

    Conclusions:

    • A 2-step awake craniotomy is a rare, effective, and safe strategy for diffuse gliomas when initial procedures are prematurely stopped.
    • Patients with attention deficits, left-sided lesions, or insular tumor involvement are more likely to require this staged approach.