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Background <p>Awake surgery is the reference for diffuse low-grade glioma resection, allowing maximal tumor removal while preserving neurocognitive functions. It is also applicable to other brain tumors. However, key technical elements must be followed to ensure optimal conditions for intraoperative cognitive testing and reliable functional mapping.</p> Method <p>We describe the asleep–awake–asleep technique with real-time cognitive monitoring and provide practical guidance for safe and effective implementation.</p> Conclusion <p>Success relies on rigorous intraoperative standards to optimize functional mapping. Beyond oncological outcomes, this surgical philosophy preserves quality of life by respecting individual brain organization, reflecting a shift toward personalized functional neurooncology.</p>

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Awake surgery with direct electrical stimulation mapping and real-time cognitive monitoring for functionally guided tumor resection: how we do it

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年9月6日

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  • Fabien Almairac,
  • Hugues Duffau

摘要

Background

Awake surgery is the reference for diffuse low-grade glioma resection, allowing maximal tumor removal while preserving neurocognitive functions. It is also applicable to other brain tumors. However, key technical elements must be followed to ensure optimal conditions for intraoperative cognitive testing and reliable functional mapping.

Method

We describe the asleep–awake–asleep technique with real-time cognitive monitoring and provide practical guidance for safe and effective implementation.

Conclusion

Success relies on rigorous intraoperative standards to optimize functional mapping. Beyond oncological outcomes, this surgical philosophy preserves quality of life by respecting individual brain organization, reflecting a shift toward personalized functional neurooncology.