Background:
Awake glioma surgery in pregnant patients occurs rarely and is a huge challenge for the whole therapeutic team, requiring the cooperation of a neurosurgeon, an anaesthetist, a speech therapist and an obstetrician. In this paper we present the case of a 31-year-old patient in 22 hbd with low grade glioma (LGG) of the left temporal lobe. The patient was admitted to the outpatient clinic, having experienced transient speech disorders for about a week. An MRI examination revealed an extensive tumour in the left temporal region. The speech cortical centres were mapped using fMRI and the awake surgery was tailored. The surgery was performed under neuroleptanalgesia with dexmedetomidine and remifentanil and regional anaesthesia. The speech centres were located. The tumour was completely removed, revealing astrocytoma fibrillare WHO II. The patient’s speech was continuously monitored, as well as the foetal vital functions. The course of the pregnancy was uneventful. In the 48th month after the first operation, the patient underwent a reoperation due to tumour recurrence with consecutive protonotherapy. Currently, 88 months after the first operation, the patient and child both remain in very good condition

Conclusions:
Few cases of glioma resection with intraoperative awakening in pregnant women have been described in the literature. The awake method seems to be an optimal treatment option.