Advances in Awake Craniotomy for Gliomas and Epilepsy Surgery with Real-Time Language and Motor Mapping: A Comprehensive Review

Authors: Shivam Dubey

DOI: 10.18231/j.ijashnb.13393.1760358302

Keywords: Awake craniotomy, gliomas, epilepsy surgery, intraoperative mapping, language preservation, motor mapping, connectomics, brain–computer interface

Abstract: Awake craniotomy (AC) has resurfaced as a revolutionary neurosurgical technique that facilitates maximal safe glioma resection and individualized epilepsy surgery by allowing real-time functional mapping. Direct patient involvement during surgery by AC equips surgeons with the option of preserving key cortical and subcortical networks, including language and motor functions, while attaining the best oncological or seizure control. This review integrates recent progress in awake craniotomy, highlighting anaesthesia protocols, integration of neurophysiology and neuroimaging, real-time cortical and subcortical mapping, and their applications in gliomas and epilepsy. Clinical results are measured in terms of survival, seizure freedom, and preservation of function. Patient selection, intraoperative heterogeneity, and mapping shortages are addressed among challenges, as well as future directions, such as connectome-based neurosurgery, artificial intelligence (AI), and brain–computer interfaces. The data indicate that AC, along with next-generation mapping techniques, will continue to be the core of precision neurosurgery for the next few decades.