CHSU Discovery

Abstract

Awake craniotomy with intraoperative brain mapping and testing has become the gold standard for resection of brain tumors in eloquent areas, allowing maximal safe resection while preserving neurological function. The asleep-awake-asleep (SAS) technique and monitored anesthesia care (MAC) have demonstrated equal efficacy for performing intraoperative brain mapping. Propofol-remifentanyl sedation is a well-established anesthetic regimen for awake craniotomy, providing adequate sedation, analgesia, and rapid awakening for neurological assessment. Glioblastoma multiforme (GBM) in eloquent areas presents unique surgical challenges. Recent evidence suggests that awake craniotomy for eloquent GBM is associated with greater extent of resection, reduced neurological deficits, and improved overall survival compared to asleep resection. The GLIOMAP study demonstrated that awake craniotomy led to improved outcomes particularly in patients younger than 70 years with good preoperative performance status.