Awake craniotomy is sometimes used to help preserve neurological function after brain surgery. However, it is unclear if this technique is necessary or beneficial in glioblastoma (GBM). GLIOMAP is a huge multicenter cohort of patients who underwent awake craniotomy for primary, unifocal GBM in eloquent locations (motor or sensory areas, language areas, visual areas). Out of a cohort of nearly 4000 patients (including 1074 awake craniotomies), 134 patients who had awake craniotomy were propensity-matched with 402 patients who had asleep craniotomy. While patient and tumor characteristics were extensively accounted for, we must remember this was a retrospective cohort where individual surgeons determined who did or did not have awake resections. Patients who had awake resection had significantly fewer neuro deficits at 6 months (26% v 41%), longer median overall survival (17 v 14 months), and longer median progression free survival (9 v 7.3 months). Among subgroups, patients <70 with good performance status (KPS 90-100) and good neurological function had better OS with awake resection. | Gerritsen, Lancet Oncol 2022
