Awake craniotomy in glioma and epilepsy – A scoping review and consideration of similarities and differences

Background Awake craniotomy (AWC) is preferred when surgical procedures are performed near eloquent areas of the brain, commonly in the surgical treatment of gliomas and occasionally in epilepsy surgery. AWC is reported to offer better surgical outcomes with low complication rates in both entities. However, despite some similarities, differences in aspects of AWC between these two entities have not been comprehensively described in the literature. Methods We searched the PubMed and Scopus database up to March 2024. Abstracts were screened and studies meeting the eligibility criteria were selected for detailed exploration. Results The first search yielded 13 studies. However, thorough assessment identified only one study as potentially addressing our primary question of interest. The second search yielded 309 eligible studies, of which only four studies were deemed suitable for inclusion in the final review. However, thorough review revealed that none of the last four candidates met the criteria for inclusion in the review. Conclusions This likely indicates that the differences regarding AWC between epilepsy surgery and glioma surgery are not well established among neurosurgeons. This scoping review presents a discussion of similar and different aspects that might influence the consideration of AWC. Both entities share similarities including defining a “safe entry” and “boundary” for resective surgery. However, these entities differ in terms of patient age, neuroplasticity target of surgery, extent of resection, number of chances to perform surgery, purpose of surgery, possibility of increased intracranial pressure and role of AWC. Neurosurgeons should be aware of similarities and differences in the ap-plication of AWC between glioma and epilepsy surgeries.