{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T14:20:57Z","timestamp":1788272457956,"version":"build-2803163510"},"reference-count":9,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Chin Neurosurg Jl"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>To descriptively evaluate short-term (48\u201372\u00a0h postoperatively) neurological functional outcomes in patients undergoing awake craniotomy for intracranial lesions located within eloquent brain areas, and conduct univariate exploratory analyses of clinical factors correlated with acute postoperative neurological deterioration. Secondary exploratory survival analyses are included solely for hypothesis generation; all survival-related findings carry no definitive clinical prognostic interpretation given the study\u2019s critical limitations of small sample size, pathological heterogeneity, absent long-term functional follow-up, and missing key perioperative covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A single-center descriptive retrospective analysis was performed on 30 patients who received awake craniotomy between January 2019 and November 2024. The primary predefined endpoint was new or exacerbated neurological deficits within 48\u201372\u00a0h after surgery, quantified via Karnofsky Performance Status (KPS), Glasgow Coma Scale (GCS), Mini-Mental State Examination (MMSE), and manual muscle strength testing. Early postoperative dysfunction was categorized into three distinct phenotypes: transient global systemic functional decline, focal motor neurological deficits, and isolated language impairment (aphasia). Secondary exploratory endpoints included overall survival and all-cause mortality, with follow-up completed by February 28, 2025. Univariate logistic regression screened correlates of acute neurological decline; Kaplan\u2013Meier survival curves, log-rank subgroup comparisons, and Cox proportional hazards regression were applied for exploratory survival modeling. All survival analyses are interpreted as purely descriptive and hypothesis-generating, with no confirmatory clinical value; the specific constraints are addressed in the Limitations section.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The cohort contained 30 patients, with an awake craniotomy intraoperative mapping completion rate of 90.0% (27\/30). Within 48\u201372\u00a0h postoperatively, 30.0% (9\/30) of patients developed new or aggravated acute neurological dysfunction. Most acute impairments reflected transient global functional decline, including KPS reduction (30.0%) and MMSE cognitive decline (26.7%), while permanent focal injury surrogates (new motor weakness 16.7%; new-onset aphasia 10.0%) were far less frequent. We emphasize that early KPS\/MMSE reductions largely stem from temporary perioperative cerebral edema, postoperative fatigue, and residual sedation recovery rather than irreversible focal brain injury. Patients with successful intraoperative awake mapping exhibited a numerically lower rate of acute neurological decline (25.9%) versus patients with mapping failure (66.7%), though this trend did not reach statistical significance (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.20). Univariate logistic regression identified no statistically significant independent predictors of acute postoperative neurological deficits. Median overall survival for the entire cohort was 43.0\u00a0months; all subgroup survival comparisons and Cox regression hazard models yielded non-significant results, with no reliable prognostic factors identified in this limited cohort.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Awake craniotomy combined with direct electrical stimulation mapping is technically feasible and effectively limits permanent language dysfunction in patients with eloquent cortex lesions. Transient short-term global functional deterioration is common in the immediate postoperative window, driven by reversible perioperative physiological disturbances rather than definitive surgical neurological injury. Owing to the retrospective single-center design, small sample size, heterogeneous intracranial pathology, absence of long-term (\u2265\u20093-month) functional outcome assessments, lack of a general anesthesia control group, and unmeasured critical covariates (including extent of resection), all survival and mortality-related analyses are strictly exploratory and cannot support clinical prognostic judgements. Large, pathology-stratified controlled prospective studies incorporating serial long-term neurological evaluations are required to validate definitive risk factors and long-term functional benefits of awake craniotomy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s41016-026-00443-9","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T13:53:30Z","timestamp":1788270810000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Neurological outcomes and survival in patients with intracranial lesions undergoing awake craniotomy: a descriptive retrospective single-center study"],"prefix":"10.1186","volume":"12","author":[{"given":"Yajie","family":"Song","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaiwen","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yushun","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Shen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yizhuo","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhennan","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,1]]},"reference":[{"key":"443_CR1","doi-asserted-by":"publisher","unstructured":"Coll\u00e9e E, Vincent A, Visch-Brink E, De Witte E, Dirven C, Satoer D. Localization patterns of speech and language errors during awake brain surgery: a systematic review. Neurosurg Rev. 2023;46(1):38. https:\/\/doi.org\/10.1007\/s10143-022-01943-9.","DOI":"10.1007\/s10143-022-01943-9"},{"key":"443_CR2","doi-asserted-by":"publisher","unstructured":"Saito T, Muragaki Y, Maruyama T, Tamura M, Nitta M, Okada Y. Intraoperative functional mapping and monitoring during glioma surgery. Neurol Med Chir (Tokyo). 2015;55(1):1\u201313. https:\/\/doi.org\/10.2176\/nmc.ra.2014-0215.","DOI":"10.2176\/nmc.ra.2014-0215"},{"key":"443_CR3","doi-asserted-by":"publisher","unstructured":"Vooijs M, et al. Level I and II deficits\u2014a clinical survey on international practice of awake craniotomy and definitions of postoperative \"major\" and \"minor\" deficits. Neuro-Oncol Adv. 2024;6(1):vdae206. https:\/\/doi.org\/10.1093\/noajnl\/vdae206.","DOI":"10.1093\/noajnl\/vdae206"},{"key":"443_CR4","doi-asserted-by":"publisher","unstructured":"Yao SJ. Preliminary study of awake craniotomy for recurrent glioma in eloquent brain areas. Chin J Mod Neurol Dis. 2025;25(3):207. https:\/\/doi.org\/10.3969\/j.issn.1672-6731.2025.03.007.","DOI":"10.3969\/j.issn.1672-6731.2025.03.007"},{"key":"443_CR5","doi-asserted-by":"publisher","unstructured":"Honeyman SI. Awake versus asleep craniotomy for eloquent glioblastoma: a systematic review and meta-analysis. Neurosurg Rev. 2025;48(1):628. https:\/\/doi.org\/10.1007\/s10143-025-03787-5.","DOI":"10.1007\/s10143-025-03787-5"},{"key":"443_CR6","doi-asserted-by":"publisher","unstructured":"Ramakrishnan PK, Saeed F, Thomson S, Corns R, Mathew RK, Sivakumar G. Awake craniotomy for high-grade gliomas \u2013 a prospective cohort study in a UK tertiary centre [Preprint]. 2023. https:\/\/doi.org\/10.21203\/rs.3.rs-2723136\/v1.","DOI":"10.21203\/rs.3.rs-2723136\/v1"},{"key":"443_CR7","doi-asserted-by":"publisher","unstructured":"Gerritsen JKW, et al. Effect of awake craniotomy in glioblastoma in eloquent areas (GLIOMAP): a propensity score-matched analysis of an international, multicentre, cohort study. Lancet Oncol. 2022;23(6):802\u201317. https:\/\/doi.org\/10.1016\/S1470-2045(22)00213-3.","DOI":"10.1016\/S1470-2045(22)00213-3"},{"key":"443_CR8","doi-asserted-by":"publisher","unstructured":"Graffeo CS, Scherschinski L, Baranoski JF, Srinivasan VM, Lawton MT. Microsurgical resection of a lateral pontine arteriovenous malformation masquerading as a cavernous malformation: 2-dimensional operative video. Oper Neurosurg. 2024;27(3):386. https:\/\/doi.org\/10.1227\/ons.0000000000001123.","DOI":"10.1227\/ons.0000000000001123"},{"key":"443_CR9","doi-asserted-by":"publisher","unstructured":"Sanai N, Berger MS. Surgical oncology for gliomas: the state of the art. Nat Rev Clin Oncol. 2018;15(2):112-125. https:\/\/doi.org\/10.1038\/nrclinonc.2017.171.","DOI":"10.1038\/nrclinonc.2017.171"}],"container-title":["Chinese Neurosurgical Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s41016-026-00443-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s41016-026-00443-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s41016-026-00443-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T13:53:32Z","timestamp":1788270812000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s41016-026-00443-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,1]]},"references-count":9,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["443"],"URL":"https:\/\/doi.org\/10.1186\/s41016-026-00443-9","relation":{},"ISSN":["2057-4967"],"issn-type":[{"value":"2057-4967","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,1]]},"assertion":[{"value":"26 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 September 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This retrospective clinical study was reviewed and approved by the Ethics Committee of the Second People\u2019s Hospital of Changzhou (Approval No.: [2021]KY005-1).","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not Applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"26"}}