gms | German Medical Science

Objective: During awake craniotomy, a neuropsychologist is regarded as a highly valuable partner for us neurosurgeons. Yet, there are some centers who do not involve neuropsychologists during awake surgery. The aim of this study was to investigate whether there is a difference in clinical outcome measures between patients that underwent awake craniotomy for tumor removal with and without the attendance of a neuropsychologist.

Methods: 68 patients that underwent awake craniotomy for resection of presumably language-eloquent tumors were included in our analysis. 54 awake craniotomies were done under condition of neuropsychological support (NP). 14 awake surgeries were performed without a neuropsychologist (non-NP) due to language barrier between the neuropsychologist and the patient. In these patients, neuropsychological evaluation was provided by a bilingual resident speaking the mother tongue of the respective patient.

Results: Both groups were highly comparable regarding age, gender, and tumor entity. However, gross total resection (GTR) rate was significantly higher in the NP group (NP vs. non-NP: 63.0% vs. 28.6%, p=0.02) whilst duration of surgery was shorter (235.6 vs. 286.6 min, p<0.01). Furthermore, the rate of unexpected residual tumor (estimation of the intraoperative extent of resection vs. postoperative imaging) was lower within the NP group (16.7% vs. 42.9%, p=0.04), but no statistically significant difference in terms of permanent surgery-related language deterioration was observed when comparing the NP and non-NP group (5.6% vs. 14.3%, p=0.26).

Conclusion: Although our non-NP cohort is small, our data emphasize the need for professional neuropsychological evaluation during awake craniotomy.