822 Awake Craniotomy Within Glioblastoma Subgroups (GLIOMAP study)

Abstract

INTRODUCTION: Awake mapping has been associated with decreased neurological deficits and increased extent of resection in eloquent glioma resections. However, its impact within clinically relevant glioblastoma subgroups remains poorly understood. METHODS: 918 patients with tumor resection for primary eloquent glioblastoma between 2010 and 2020 at four tertiary centers from Europe and the United States were included from an initial cohort of 4075 patients. Awake patients were matched with asleep patients for the overall cohort and subgroups. RESULTS: Overall, awake mapping led to less neurological deficits at 6 weeks (18.4% vs. 27.8%, p = 0.036) and 6 months postoperatively (26.5% vs. 41.9%, p = 0.0039), lower residual volume (mean: 1.9 vs. 6.4 ml, p = 0.0076), a higher extent of resection (mean: 95.5% vs. 85.3%; median: 99.8% vs. 94.0%, p < 0.001), and longer overall survival (median: 20.0 vs. 18.5 months, p = 0.042). Awake mapping led in the subgroups of age < 70, age = 70, preoperative NIHSS score 0-1 and preoperative KPS 90-100 to less postoperative neurological deficits at 6 weeks and 6 months. For patients in the KPS = 80 subgroup, awake mapping led to less postoperative neurological deficits at 6 months (22.0% vs. 45.9%, p = 0.026). Patients aged < 70 years undergoing awake craniotomy had on average a longer overall survival than the asleep resection group (median: 24 months vs. 20.5 months, p= 0.031). Awake mapping was an independent predictor for receiving adjuvant chemotherapy and radiotherapy (OR for no receival: 0.40, p = 0.025), gross-total resection based on residual volume (OR 2.79, p = 0.041), and gross-total resection based on extent of resection (OR 2.24, p = 0.002). Moreover, it had a positive impact on overall survival in the = 70 subgroup (HR 0.08, p = 0.033), but a negative impact on overall survival in the NIHSS = 2 subgroup (HR 3.07, p = 0.014). CONCLUSIONS: Awake mapping prevents postoperative neurological deterioration in eloquent glioblastoma resections for patients aged <70, aged = 70, with a preoperative NIHSS score of 0-1 or preoperative KPS of 90-100 and increases the rate of gross-total resections in all patients.