WHAT ARE THE CHALLENGES AND OPPORTUNITIES IN AWAKE CRANIOTOMIES DELIVERY IN UK NEURO-ONCOLOGY CENTRES? INSIGHTS FROM THE TESSA JOWELL BRAIN CANCER MISSION

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Abstract AIMS Awake craniotomies (ACs) are increasingly seen as the gold standard for resecting tumours in eloquent regions of the brain. However, insights collected through the TJ (Tessa Jowell) Academy suggest that there is variation in how ACs are delivered in the UK, potentially impacting which patients have an AC and who supports these surgeries. To explore this variation we conducted a thorough review of AC delivery in 22 UK neuro-oncology centres as part of the TJ CoE (Centre of Excellence) programme. METHODS UK neuro-oncology centres applying for TJ CoE in 2024 detailed the number of ACs delivered each year, and were asked to describe which allied health professional (AHP) specialties supported these procedures. Data were grouped by theme and analysed, and are presented here anonymously. RESULTS While all 22 centres applying for TJ CoE in 2024 conducted awake craniotomies, the percentage of surgeries done awake varied from 3% to 39%. The split between high- and low-grade patients varied, with three centres only operating awake on low-grade tumours. The number of distinct AHP specialties supporting ACs (dependent on the patients’ needs/tumour location) var- ied from 1 to 6: the most common specialties were speech and language therapist (SLT) and neuropsychologist (both 16/22, 73%) followed by physiotherapist (10/22, 45%) and neurophysiologist (9/22, 41%). Only a minority of centres reported that all their AHPs had time funded for the AC pathway (36%, 8/22), and 7/22 centres reported no AC-specific training for AHPs. CONCLUSION These findings suggest that the existing lack of guidelines on AC delivery has led to variation in which patients are operated on, and which AHPs support these surgeries. These data will inform the upcoming publication of national guidance on ACs by the TJ Academy’s physiotherapy, SLT and neuropsychology task-and-finish groups, with the aim to encourage a more standardised approach to AC delivery across the UK.

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