Objective:

To summarize and appraise published case reports on awake craniotomy (AC) in patients with hearing impairment, focusing on intraoperative communication strategies, mapping paradigms, perioperative feasibility, and neurological outcomes, while addressing the unique challenges faced by this population.

Key Findings:

• Awake craniotomy is traditionally contraindicated for deaf patients due to communication barriers, which may limit access to surgical benefits.
• Sign language processing engages classical language networks and introduces unique complexities during AC, necessitating tailored approaches.
• Emerging case reports indicate that AC can be feasible for hearing-impaired patients with individualized communication strategies, suggesting a need for further exploration.

Interpretation:

The existing literature on AC in hearing-impaired patients is sparse and fragmented, highlighting the urgent need for more comprehensive studies to inform clinical practices and improve patient outcomes.

Limitations:

• Lack of consolidated evidence and methodological limitations due to the exploratory nature of the review, including potential biases in case reporting.
• Absence of protocol registration prior to study initiation, which may affect the transparency of the review process.

Conclusion:

Despite challenges, AC may be technically feasible in selected hearing-impaired patients when individualized communication strategies are employed, warranting further research.