A recent study conducted by Professor Fang Liu and colleagues from Nanjing Medical University found that approximately 30% of patients who undergo awake craniotomy experience early neurological deterioration within the first 48 to 72 hours following surgery. The research team analyzed data from 30 patients who were treated for intracranial lesions between January 2019 and November 2024. To assess patient function, the team utilized the Karnofsky Performance Status, Glasgow Coma Scale, and Mini-Mental State Examination three days post-operation.
The complexities of awake craniotomy
Awake craniotomy is a surgical procedure that allows doctors to operate on brain lesions located near areas responsible for critical functions, such as movement and language, while the patient remains awake. This technique employs direct electrical stimulation to identify functional brain regions, enabling surgeons to remove lesions while preserving essential abilities. However, interpreting neurological changes in the immediate postoperative period can be challenging due to temporary effects such as cerebral edema, fatigue, and residual sedation, which may impact functional assessments.
The study’s results revealed that 9 out of 30 patients, or 30%, experienced new or worsened acute neurological dysfunction within 48 to 72 hours. A decline of at least 10 points in the Karnofsky Performance Status was observed in 30% of patients, while 26.7% experienced a decrease of at least two points in the Mini-Mental State Examination. Additionally, 16.7% of patients exhibited new or worsened motor weakness, and 10% developed new-onset aphasia. Intraoperative awake mapping was successfully completed in 27 patients, or 90%, while three patients required conversion to general anesthesia without completing functional mapping.
Although patients with successful mapping had a lower rate of acute neurological decline compared to those with mapping failure, the difference was not statistically significant. Univariate analyses did not identify any statistically significant clinical predictors of acute deterioration. As Prof. Liu noted, early functional changes should not be automatically interpreted as permanent surgical injury, as scores obtained soon after surgery can be influenced by temporary postoperative effects.
Survival outcomes and study limitations
The research team also explored survival outcomes, although these analyses were exploratory in nature. During follow-up, 17 patients died, and the median overall survival was 43 months. No statistically significant differences in survival or independent prognostic factors were identified. The researchers emphasized that these findings should be interpreted with caution due to the small sample size, diverse intracranial pathologies, and lack of long-term neurological assessments.