Awake craniotomy for high-grade gliomas – a prospective cohort study in a UK tertiary- centre

Abstract Background: Awake craniotomy (AC) is preferred for maximising extent of resection (EOR) in high-grade glioma (HGG) in eloquent regions without worsening neurological function. Studies from the UK reporting on AC include a heterogenous group of patients which limit the evaluation of the true impact of AC in HGG patients. This study aims to report solely the experience and outcomes of AC for HGG surgery from our centre. Methods: A prospective review of all patients who underwent AC for HGG from 2013–2019 were performed. Data on patient characteristics including but not limited to demographics, pre- and post-operative Karnofsky performance status (KPS), tumour location and volume, type of surgery, EOR, tumour histopathology, intra- and post-operative complications, morbidity, mortality, disease recurrence, progression-free survival (PFS) and overall survival (OS) from the time of surgery were collected. Results: Fifteen patients (6 males;9 females;17 surgeries) underwent AC for HGG (median age:55; range:26–73 years). Two patients underwent repeat surgeries due to disease recurrence. Median pre- and post-operative KPS score was 90 (range:80–100) and 90 (range:60–100), respectively. The EOR ranges from 60–100% with a minimum of 80% achieved in 81.3% cases. There were 15 cases of glioblastoma IDH-wildtype, CNS WHO Grade 4, 1 case of oligodendroglioma IDH-mutant 1p/19-codeleted, CNS WHO grade 3, and 1 case of Astrocytoma IDH-mutant, CNS WHO grade 3. Post-operative complications include focal seizures (17.6%), transient aphasia/dysphasia (17.6%), permanent motor deficit (11.8%), transient motor deficit (5.9%) and transient sensory disturbance(5.9%). There were no surgery-related mortality or post-operative infection. The median PFS and OS were 13 (95%CI 5–78) and 30 (95%CI 21–78) months, respectively. Conclusion: This is the first study in the UK to solely report outcomes of AC for HGG surgery. Our data demonstrates that AC for HGG in eloquent region is safe and feasible and provides comparable outcomes to those reported in the literature.