Awake craniotomy as a routine pathway for supratentorial tumor surgery: A 500-case awake-craniotomy experience with institutional resource and charge benchmarking.
5 affiliations
- 1Department of Neurosurgery, Centro Internacional de Cáncer, San Salvador, El Salvador.
- 2Department of Radiosurgery, Centro Internacional de Cáncer, San Salvador, El Salvador.
- 3Department of Anesthesiology, Hospital de Diagnóstico, San Salvador, El Salvador.
- 4Department of Neurosurgery, Salvadorian Institute of Social Security, San Salvador, El Salvador.
- 5Department of Neurosurgery, Hospital de Diagnóstico, San Salvador, El Salvador.
Abstract
Background
Integrated safety, tolerability, and resource data on awake craniotomy in resource-constrained settings are lacking. Improving accessibility has remained central to our program. We report an experience exceeding 500 awake craniotomies with structured comparator synthesis.Methods
Three nested cohorts from one Central American institution were analyzed: 218 awake craniotomies (2007-2018, audited safety), 500 procedures spanning neoplastic and non-neoplastic lesions (2007-2026, program tolerability), and 30 awake versus 30 contemporaneous general-anesthesia craniotomies (2024-2026, descriptive benchmarking). The two contemporary groups were restricted to elective supratentorial intraparenchymal tumor resections. The contemporary cohort was derived from billing and administrative records; baseline clinical, radiological, and histopathological data were unavailable; groups were managed by different teams.Results
Across the 500-case program, completion without conversion was 99.0%; 30-day mortality, ascertainable only for the 282 registry-era procedures, was 3.2%. In the 218-case cohort, seizures occurred in 5.1%, perioperative mortality was 0.5%, and none required ventilation; extent of resection was 73%, 94%, and 100% in eloquent, adjacent to eloquence, and non-eloquent cortex. In the contemporaneous institutional benchmark, the awake pathway showed shorter stay (1.0 vs. 2.0 days), no intensive-care use (0/30 vs. 9/30), shorter incision-to-closure time, and $5,205 lower median billed charges than the general-anesthesia pathway. Outcomes were consistent with 14 comparator studies.Conclusion
In this high-volume, resource-constrained program, to the best of our knowledge, the only protocolized awake-craniotomy program in the region, awake craniotomy served as a routine pathway for eligible supratentorial intraparenchymal lesions, with high completion, favorable safety, short hospitalization, no intensive-care admission, and lower observed billed charges than conventional practice.
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BibTeX
@article{lovo2026awake,
title = {{Awake craniotomy as a routine pathway for supratentorial tumor surgery: A 500-case awake-craniotomy experience with institutional resource and charge benchmarking.}},
author = {Eduardo E Lovo and Jesus Antonio Rodriguez Santos and Claudia Cruz and José Ernesto Chang and Mario Humberto Minervini},
journal = {Surgical neurology international},
year = {2026},
month = oct,
doi = {10.25259/sni_854_2026},
url = {https://europepmc.org/article/MED/42974532},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Awake craniotomy as a routine pathway for supratentorial tumor surgery: A 500-case awake-craniotomy experience with institutional resource and charge benchmarking.
AU - Eduardo E Lovo
AU - Jesus Antonio Rodriguez Santos
AU - Claudia Cruz
AU - José Ernesto Chang
AU - Mario Humberto Minervini
PY - 2026
DA - 2026/10/16
JO - Surgical neurology international
DO - 10.25259/sni_854_2026
UR - https://europepmc.org/article/MED/42974532
AB - Background Integrated safety, tolerability, and resource data on awake craniotomy in resource-constrained settings are lacking. Improving accessibility has remained central to our program. We report an experience exceeding 500 awake craniotomies with structured comparator synthesis.Methods Three nested cohorts from one Central American institution were analyzed: 218 awake craniotomies (2007-2018, audited safety), 500 procedures spanning neoplastic and non-neoplastic lesions (2007-2026, program tolerability), and 30 awake versus 30 contemporaneous general-anesthesia craniotomies (2024-2026, descriptive benchmarking). The two contemporary groups were restricted to elective supratentorial intraparenchymal tumor resections. The contemporary cohort was derived from billing and administrative records; baseline clinical, radiological, and histopathological data were unavailable; groups were managed by different teams.Results Across the 500-case program, completion without conversion was 99.0%; 30-day mortality, ascertainable only for the 282 registry-era procedures, was 3.2%. In the 218-case cohort, seizures occurred in 5.1%, perioperative mortality was 0.5%, and none required ventilation; extent of resection was 73%, 94%, and 100% in eloquent, adjacent to eloquence, and non-eloquent cortex. In the contemporaneous institutional benchmark, the awake pathway showed shorter stay (1.0 vs. 2.0 days), no intensive-care use (0/30 vs. 9/30), shorter incision-to-closure time, and $5,205 lower median billed charges than the general-anesthesia pathway. Outcomes were consistent with 14 comparator studies.Conclusion In this high-volume, resource-constrained program, to the best of our knowledge, the only protocolized awake-craniotomy program in the region, awake craniotomy served as a routine pathway for eligible supratentorial intraparenchymal lesions, with high completion, favorable safety, short hospitalization, no intensive-care admission, and lower observed billed charges than conventional practice.
SN - 2229-5097
SN - 2152-7806
ER -