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Purpose <p>Awake surgery (AS) has emerged as a valuable alternative to surgery under general anesthesia (GA) in the treatment of Diffuse Low Grade Gliomas (DLGGs). Despite the growing body of literature supporting AS in glioma surgery, no meta-analysis has yet specifically addressed its efficacy and safety in the treatment of DLGGs. We conducted a meta-analysis of cranial comparing AS and GA in treatment of DLGGs.</p> Methods <p>We systematically reviewed the literature from PubMed, Embase, and Cochrane databases. The outcomes of interest were overall survival (OS), extent of resection (EOR), and immediate and long-term postoperative neurofunctional deficits (PNDs). Statistical analysis was performed using Review Manager 5.4.1.</p> Results <p>12 studies were included, with 895 patients, 464 (51.84%) in the AS group, and a mean follow-up of 47.22 ± 55.52 months. At 5 years, AS was associated with a 28% higher OS (<i>p</i> = 0.006; I² = 32%). In the comparison without supplementary intraoperative techniques (SIT), AS demonstrated a mean EOR over 30% higher (<i>p</i> &lt; 0.0001; I² = 81%). Regarding long-term PNDs, AS significantly reduced risk, with a 72% lower risk overall (<i>p</i> &lt; 0.0001; I² = 0%) and a 70% lower risk in the subgroup without SIT (<i>p</i> = 0.0003; I² = 0%). No statistically significant differences were observed in other analyses.</p> Conclusion <p>In the pursuit of achieving the best oncological-functional balance for patients, AS emerges as a preferable option for the treatment of DLGGs. Despite these relevant findings, caution is warranted in interpreting the results due to the limitations of the included studies.</p>

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Awake surgery versus general anesthesia in the treatment of Diffuse Low-Grade Gliomas – and the role of supplementary intraoperative techniques: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2026年1月27日

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  • Thiago Luís Marques Lopes,
  • Mateus Dutra Balsells,
  • Marconny Alexandre Cavalcante,
  • Andressa Gabriella Duarte de Queiroz,
  • Hildel Freire Leite Filho,
  • Miguel Vieira de Almeida,
  • Yan Gondim de Sousa,
  • Luís Eduardo Oliveira Matos,
  • Allan Dias Polverini,
  • Lucas Alverne Freitas de Albuquerque,
  • Hugues Duffau

摘要

Purpose

Awake surgery (AS) has emerged as a valuable alternative to surgery under general anesthesia (GA) in the treatment of Diffuse Low Grade Gliomas (DLGGs). Despite the growing body of literature supporting AS in glioma surgery, no meta-analysis has yet specifically addressed its efficacy and safety in the treatment of DLGGs. We conducted a meta-analysis of cranial comparing AS and GA in treatment of DLGGs.

Methods

We systematically reviewed the literature from PubMed, Embase, and Cochrane databases. The outcomes of interest were overall survival (OS), extent of resection (EOR), and immediate and long-term postoperative neurofunctional deficits (PNDs). Statistical analysis was performed using Review Manager 5.4.1.

Results

12 studies were included, with 895 patients, 464 (51.84%) in the AS group, and a mean follow-up of 47.22 ± 55.52 months. At 5 years, AS was associated with a 28% higher OS (p = 0.006; I² = 32%). In the comparison without supplementary intraoperative techniques (SIT), AS demonstrated a mean EOR over 30% higher (p < 0.0001; I² = 81%). Regarding long-term PNDs, AS significantly reduced risk, with a 72% lower risk overall (p < 0.0001; I² = 0%) and a 70% lower risk in the subgroup without SIT (p = 0.0003; I² = 0%). No statistically significant differences were observed in other analyses.

Conclusion

In the pursuit of achieving the best oncological-functional balance for patients, AS emerges as a preferable option for the treatment of DLGGs. Despite these relevant findings, caution is warranted in interpreting the results due to the limitations of the included studies.