883 Impact of Awake Craniotomy within Eloquent Glioblastoma Subgroups (GLIOMAP): A Propensity-Score Matched Analysis of an International, Multicenter, Cohort 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: Propensity-score matching with a 1:3 ratio was used to match awake with asleep patients for the overall cohort and subgroups stratified by age, NIHSS score and KPS. Cox proportional-hazard regressions and multiple multivarible logistic regressions were performed to analyze the independent impact of awake mapping. RESULTS: 1047 patients with resection for primary eloquent glioblastoma between 2010 and 2020 were included. Overall, awake craniotomy resulted in fewer neurological deficits at 3 months and 6 months postoperatively; a lower residual tumor volume, a higher extent of resection, longer overall survival and progression-free survival. Regression analyses independently associated awake craniotomy with gross-total resection and overall survival. Awake craniotomy led in all subgroups to a higher extent of resection and in the subgroups age <70, NIHSS 0-1, NIHSS ≥ 2 and KPS 90-100 to less postoperative neurological deficits at 3 months and 6 months. For patients in the ≥70 years subgroup and KPS ≤ 80 subgroup, awake craniotomy led to less postoperative neurological deficits at 3 months (≥70 years) or 6 months (KPS ≤ 80). Median overall survival and progression-free survival were longer for the awake group in the subgroups aged <70, NIHSS 0-1 and KPS 90-100. CONCLUSIONS: Awake craniotomy was especially suitable in patients aged <70, with NIHSS score 0-1 or KPS 90-100, leading to decreased neurological morbidity, increased amount of tumor resection and improved OS and PFS. In patients aged ≥ 70, with NIHSS score ≥2 or KPS ≤ 80, awake craniotomy could be useful to prevent late deficits or to help patients maintain their performance status to undergo adjuvant therapy.