[Comprehensive Preoperative Preparation for Awake Craniotomy]

Awake craniotomy requires comprehensive preoperative preparation that differs fundamentally from conventional tumor resection performed under general anesthesia. Successful awake surgery depends not only on the technical expertise of the neurosurgeon but also on close multidisciplinary collaboration among anesthesiologists, neuropsychologists, nurses, and technical staffs, as well as active patient participation. Preoperative planning plays a crucial role in ensuring intraoperative safety and preserving neurological function. Careful patient selection is essential and includes assessment of neurological status, seizure history, age, and anesthetic risk factors. Detailed neuropsychological evaluation is required to establish baseline cognitive function, select appropriate intraoperative tasks, and define functional targets for preservation. Integration of structural imaging, diffusion tensor tractography, and functional magnetic resonance imaging enables individualized surgical planning based on functional brain networks. Preoperative simulation in the operating room setting enhances team coordination and reduces patient anxiety. Anesthetic strategies should prioritize airway safety, reliable awakening, and seizure prevention. As intraoperative electrical stimulation carries a risk of seizures, appropriate antiepileptic management and troubleshooting strategies are necessary. Through systematic preparation, task selection, imaging integration, and multidisciplinary communication, awake craniotomy can achieve maximal tumor resection while preserving critical cognitive and functional networks. This review summarizes key preoperative considerations for neurosurgeons beginning to perform awake craniotomy.