• AlbuquerqueLucas Alverne FLAFGeneral Hospital of Fortaleza, Department of Neurosurgery, Fortaleza, Ceará, Brazil; University of Campinas, Department of Neurology, Campinas, São Paulo, Brazil. Electronic address: lucasalverne@gmail.com., Macêdo FilhoLeonardo José MLJMDepartment of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA., Felipe S Borges, Fátima C Pessoa, Gabryella S Diógenes, Cicera Jairlly V Rocha, João Paulo Almeida, and Andrei F Joaquim.
• General Hospital of Fortaleza, Department of Neurosurgery, Fortaleza, Ceará, Brazil; University of Campinas, Department of Neurology, Campinas, São Paulo, Brazil. Electronic address: lucasalverne@gmail.com.
• World Neurosurg. 2023 Jun 28.

ObjectiveDespite benefits of awake craniotomy (AC) many centers do not have access to it. We demonstrated the oncological and functional results of our initial experience in implementing AC in a context of resource limited setting.MethodsThis prospective, observational, and descriptive study collected the first 51 AC for diffuse low-grade glioma, classified according to the 2016 World Health Organization.ResultsMean age was 35.09 ± 9.91 years old. The most common clinical presentation was seizure (89.58%). The average segmented volume was 69.8 cc; with 51% of lesions with more than 6 cm in the largest diameter. Resection of more than 90% of the lesion was achieved in 49% of cases, and greater than 80% in 66.6% of cases. The mean follow-up was 835 days (2.29 years). Satisfactory Karnofsky performance status (KPS) (80 to 100) was observed in 90.1% presurgery, 50.9% at 5 days, 93.7% at 3 months, and 89.7% at 1-year postoperation. At multivariate analysis, tumor volume, new postoperative deficit, and extent of resection were related to KPS at 1 year of follow up.ConclusionsFunctional decline was clearly observed in the immediate postoperative period, but excellent recovery of functional status was observed in the medium and long term. The data presented indicate the benefits of this mapping in both cerebral hemispheres, addressing several cognitive functions in addition to motricity and language. The proposed AC model is a reproducible technique and resource sparing that can be performed safely and with good functional outcomes.Copyright © 2023 Elsevier Inc. All rights reserved.

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