Wake up.

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