Awake Craniotomy for Diffuse Low Grade Gliomas in a Resource Limited Setting: Lessons Learned with a Consecutive Series of 51 Surgeries

Abstract

Despite 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. This prospective, observational, descriptive study collected the first 51 AC for Diffuse Low Grade Glioma, classified according to the 2016 World Health Organization. Mean 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% pre-surgery, 50.9% at 5 days, 93.7% at 3 months, and 89.7% at 1-year post-op. At multivariate analysis, tumor volume, new postoperative deficit and extent of resection were related to KPS at 1 year of follow up. Functional 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, resource sparing, that can be performed safely and with good functional outcomes.