Awake versus asleep craniotomy for eloquent glioblastoma: a systematic review and meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of non-randomized comparative cohort studies
PubMed 40887547 · doi:10.1007/s10143-025-03787-5
What was done
A systematic review and meta-analysis of studies from Medline, Embase, and PubMed (up to June 30, 2025) evaluating awake craniotomy (AC) versus general anesthesia (GA) in adult patients undergoing resection for supratentorial Grade 4 eloquent glioblastoma. Assessed outcomes included extent of resection (EOR), gross total resection rates, post-operative neurological deficits, survival, and functional outcomes.
What was found
Eleven studies with 1,355 patients (402 AC, 953 GA) were analyzed: - AC achieved higher percentage EOR (MD = 7.55, 95% CI [2.94, 12.15], p = 0.001). - Gross total resection increase was not statistically significant (OR = 1.66, 95% CI [0.64, 4.35], p = 0.30). - Post-operative neurological deficits were significantly lower in the AC group (OR = 0.55, 95% CI [0.36, 0.85], p = 0.008). - Overall survival was reported as significantly higher with AC (HR = 7.99, 95% CI [2.29, 13.69], p = 0.007). - Progression-free survival showed no significant difference (HR = 2.03, 95% CI [-1.32, 5.37], p = 0.23).
Why it matters
It aggregates evidence on awake craniotomy specifically for high-grade eloquent glioblastoma, showing associations with higher resection extent and lower post-operative neurological deficits.
Limits
Composed of non-randomized comparative studies susceptible to substantial selection bias regarding patient baseline status and tumor accessibility. The abstract reports survival hazard ratio intervals with anomalous negative values without methodological explanation, and lacks detailed reporting on functional outcomes.
Cited by
- supports During brain tumor resections in eloquent areas such as the left hemisphere, awake craniotomy with intraoperative speech testing is used to identify functional boundaries and prevent speech deficits.