Chinese Neurosurgeons Report Early Neurological Outcomes After Awake Craniotomy
News related to:Chinese Neurosurgical Journal · 2 min read
Researchers from Nanjing Medical University, led by Professor Fang Liu, have published a study in the Chinese Neurosurgical Journal examining the early neurological outcomes of patients undergoing awake craniotomies. The study, which was made available online on September 1, 2026, and published in Volume 12 of the journal, focuses on the neurological changes experienced by patients within the first few days after surgery.
The research team conducted a retrospective, single-center study involving 30 patients who underwent surgery for intracranial lesions involving motor or language areas between January 2019 and November 2024. The primary objective was to assess the neurological function of these patients 48 to 72 hours post-surgery using the Karnofsky Performance Status (KPS), Glasgow Coma Scale (GCS), Mini-Mental State Examination (MMSE), and manual muscle strength testing.
The findings revealed that 9 out of the 30 patients (30%) experienced new or worsened acute neurological dysfunction within the first 48 to 72 hours after surgery. Specifically, a reduction of at least 10 points in KPS was observed in 30% of patients, while 26.7% experienced a decline of at least two points in MMSE. Additionally, 16.7% of patients showed new or worsened motor weakness, and 10% developed new-onset aphasia.
Professor Liu highlighted the importance of carefully interpreting these early functional changes, noting that temporary postoperative effects such as cerebral edema, fatigue, and residual sedation can influence functional and cognitive scores. The study found that full intraoperative awake mapping was completed in 27 patients (90%), while three required conversions to general anesthesia without completion of functional mapping.
While the researchers noted that these early functional changes should not be automatically interpreted as permanent surgical injury, they did observe a numerically lower rate of acute neurological decline in patients with successful mapping compared to those with mapping failure (25.9% versus 66.7%). However, the difference was not statistically significant.
The study also explored survival outcomes, which were found to be exploratory in nature. During follow-up, 17 patients died, and the median overall survival was 43 months. No statistically significant survival differences or independent prognostic factors were identified. The researchers acknowledged the limitations of their study, including the small sample size, diverse intracranial pathologies, and the absence of long-term functional assessments.
Professor Liu emphasized the need for larger, prospective studies involving patients with more clearly defined pathological groups. Serial assessments over at least three months could help establish how often early deficits resolve and which patients experience persistent impairment. Such evidence could support more informative postoperative counseling, rehabilitation planning, and evaluation of surgical outcomes.
The Chinese Neurosurgical Journal, an international, peer-reviewed, open-access journal, is dedicated to advancing clinical practice and research across all areas of neurosurgery.