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METHODS:

918 patients with tumor resection for primary eloquent glioblastoma between 2010 and 2020 at four tertiary centers from Europe and the United States were included from an initial cohort of 4075 patients. Awake patients were matched with asleep patients for the overall cohort and subgroups.

RESULTS:

Overall, awake mapping led to less neurological deficits at 6 weeks (18.4% vs. 27.8%, p= 0.036) and 6 months postoperatively (26.5% vs. 41.9%, p= 0.0039), lower residual volume (mean: 1.9 vs. 6.4 ml, p= 0.0076), a higher extent of resection (mean: 95.5% vs. 85.3%; median: 99.8% vs. 94.0%, p< 0.001), and longer overall survival (median: 20.0 vs. 18.5 months, p= 0.042). Awake mapping led in the subgroups of age< 70, age= 70, preoperative NIHSS score 0-1 and preoperative KPS 90-100 to less postoperative neurological deficits at 6 weeks and 6 months. For patients in the KPS= 80 subgroup, awake …