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OBJECTIVE Awake surgery is the standard treatment to preserve motor and language functions. The aim of this study is to evaluate the awake surgery for the patients with right frontal lobe (RFL) glioma on resection rate and preservation of higher cognitive functions. METHODS Out of the 139 cases that underwent awake surgery at our hospital between 2013 and 2019, 34 cases (mean age: 47.8 years) of RFL glioma were included in this study. The WHO classification was grade II, III, and IV for 15, 13, and 6 cases, respectively. We evaluated visual spatial cognition (VSC), spatial working memory (SWM), and social cognition (SC) before and after the surgery. These relevant areas were mapped intraoperatively. We did not map these areas in the cases in which the task could not be accomplished. Therefore, each function was divided into an intraoperative evaluation group (EG) and a non-evaluation group (NEG), and the resection rate and functional outcomes were compared. RESULTS The removal rate was significantly higher in the EG group for VSC and SC than that in the NEG (p= 0.0078 and 0.0024, respectively). The chronic disability rate of VSC was significantly lower in the EG than that in the NEG (5.6% vs. 31.3%, p= 0.043). None of the patients had postoperative disability of SWM in the EG which is significantly lower than that in the NEG (16.7%, p= 0.049). SC tended to have a lower disability rate (20.0%) in the EG compared to that in the NEG (45.8%). The probability that the posterior deep part of the middle frontal gyrus, which is the relevant area of VSC, was resected higher in the NEG (p= 0.0052). CONCLUSIONS We scientifically verified that the awake surgery for RFL glioma contributes to the improvement of resection rate and the preservation of higher cognitive functions.

NCOG-20. AWAKE SURGERY FOR RIGHT FRONTAL LOBE GLIOMA CAN IMPROVE THE RESECTION RATE AND PRESERVE HIGHER COGNITIVE FUNCTIONS