# Neuropsychological outcomes following awake surgery in adult glioma patients: A systematic review

## TL;DR

This review examines cognitive and emotional outcomes in adult glioma patients after awake brain surgery, highlighting recovery patterns and the need for standardized assessments.

## Contribution

The study provides a systematic analysis of neuropsychological outcomes and recovery factors in awake glioma surgery, advocating for network-based and personalized approaches.

## Key findings

- Many patients recover within 3 to 6 months post-surgery, while others face persistent deficits.
- Functional recovery is influenced by tumor resection extent and network-level reorganization.
- Methodological inconsistencies in assessments call for standardized, personalized evaluation protocols.

## Abstract

Awake craniotomy is essential for glioma resection in functionally integrated brain regions, allowing real-time monitoring to reduce cognitive and emotional deficits. Although widely used, its long-term neuropsychological effects remain debated. This systematic review aims to investigate cognitive and emotional outcomes after awake brain surgery and the factors that influence recovery, including extent of resection, follow-up timing, and neural plasticity.

This systematic review analyzes 34 studies on pre- and postoperative functional outcomes in glioma patients undergoing awake surgery. Following PRISMA guidelines, studies were selected with adult glioma patients (WHO grade I-IV) who had neuropsychological assessments before and after surgery. Data on preoperative cognitive profiles, recovery trajectories, and follow-up durations were examined, focusing on methodological consistency and assessment tools.

The findings demonstrated substantial variability in functional outcomes, with many patients recovering within 3 to 6 months post-surgery, while others experienced persistent deficits. Functional recovery was influenced not only by the extent of tumor resection but also by network-level reorganization. Methodological inconsistencies in neuropsychological assessments highlighted the need for standardized, personalized evaluation protocols, emphasizing the importance of comprehensive functional assessments.

This review emphasizes the shift from a localized cortical approach to a dynamic, network-based view of cognitive and emotional recovery. It calls for standardized, personalized neuropsychological assessments to optimize rehabilitation, along with extended follow-ups, and multidisciplinary care for long-term quality of life. Future research should refine assessment methods and strategies to better understand neuroplasticity and improve clinical outcomes in neuro-oncology.