Awake patient brain tumor surgery considerations for protocol construction

In modern functional neurooncology, awake brain surgery is the gold standard to decrease surgical morbidity and increase extent of resection. This approach increases overall survival and preserves or even improves the patient’s quality of life. Moreover, direct electrical stimulation (DES) has allowed neurosurgical teams to learn more about anatomo-functional connectivity pathways of patients. More specific cognitive screening becomes imperative both before and during surgery. Despite recent advances in technique, there is a lack of protocols taking into account these issues; in the light of this need, the authors propose a team based approach for construction of a neuropsychology protocol specifically related to brain tumor patients. This protocol will take into account this emerging neurosurgical need for more specific pre-operative screening and peri-operative neuropsychological evaluation. Such a protocol will directly benefit new neurosurgical teams starting this type of neurosurgical approach at their respective hospitals. A literature review mas made to identify the basic protocol efforts that currently exist. A team based approach included inclusion and exclusion criteria from neurosurgery, anesthesia and neuropsychology that together concluded in a robust protocol with pre-, intra- and post- operative sub protocols concluding in robust protocol.