Awake craniotomy as a routine pathway for supratentorial tumor surgery: A 500-case awake-craniotomy experience with institutional resource and charge benchmarking.

Authors

Eduardo E Lovo, Jesus Antonio Rodriguez Santos, Claudia Cruz, José Ernesto Chang, Mario Humberto Minervini

Published in

Surgical neurology international. Volume 17. Pages 580. Epub Oct 16, 2026.

Abstract

Integrated safety, tolerability, and resource data on awake craniotomy in resource-constrained settings are lacking. Improving accessibility has remained central to our program. We report an experience exceeding 500 awake craniotomies with structured comparator synthesis.
Three nested cohorts from one Central American institution were analyzed: 218 awake craniotomies (2007-2018, audited safety), 500 procedures spanning neoplastic and non-neoplastic lesions (2007-2026, program tolerability), and 30 awake versus 30 contemporaneous general-anesthesia craniotomies (2024-2026, descriptive benchmarking). The two contemporary groups were restricted to elective supratentorial intraparenchymal tumor resections. The contemporary cohort was derived from billing and administrative records; baseline clinical, radiological, and histopathological data were unavailable; groups were managed by different teams.
Across the 500-case program, completion without conversion was 99.0%; 30-day mortality, ascertainable only for the 282 registry-era procedures, was 3.2%. In the 218-case cohort, seizures occurred in 5.1%, perioperative mortality was 0.5%, and none required ventilation; extent of resection was 73%, 94%, and 100% in eloquent, adjacent to eloquence, and non-eloquent cortex. In the contemporaneous institutional benchmark, the awake pathway showed shorter stay (1.0 vs. 2.0 days), no intensive-care use (0/30 vs. 9/30), shorter incision-to-closure time, and $5,205 lower median billed charges than the general-anesthesia pathway. Outcomes were consistent with 14 comparator studies.
In this high-volume, resource-constrained program, to the best of our knowledge, the only protocolized awake-craniotomy program in the region, awake craniotomy served as a routine pathway for eligible supratentorial intraparenchymal lesions, with high completion, favorable safety, short hospitalization, no intensive-care admission, and lower observed billed charges than conventional practice.

PMID:
42974532
Bibliographic data and abstract were imported from PubMed on 03 Nov 2026.

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