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Awake Craniotomy – Cortical Mapping — SCE Neurology MCQ

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ModerateNeuro-oncologyAwake Craniotomy – Cortical MappingSCE Neurology

A 50-year-old man with late-onset epilepsy has an MRI showing a left temporal lobe diffuse glioma. He is seizure-free on levetiracetam. The neurosurgical team plans to resect the tumour under awake craniotomy. What is the purpose of awake craniotomy in this context?

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Correct answer: D — To allow intraoperative language and motor mapping with direct cortical stimulation — the patient performs tasks during surgery so the surgeon can identify and preserve eloquent cortex

Awake craniotomy allows intraoperative direct cortical stimulation (DCS) while the patient performs language and motor tasks. This enables real-time identification of eloquent cortex (language areas, motor strip), allowing maximal tumour resection while minimising the risk of postoperative neurological deficits. A: Anaesthetic risk reduction is a secondary benefit. C: The purpose is functional mapping, not pain assessment. D: Avoiding intubation is a side benefit. E: Hospital stay may or may not be shorter.

Reference: NICE NG99; ILAE Neurosurgery Commission