Outpatient supratentorial craniotomy for brain lesions: a pilot feasibility and safety study.

This single-center pilot study evaluated the feasibility, safety, and patient acceptability of fully ambulatory, home-to-home supratentorial craniotomy for intracerebral lesion resection in a European academic setting. All consecutive adults scheduled between January 2024 and July 2025 for outpatient non-emergent supratentorial craniotomy under general anesthesia for brain lesion resection were retrospectively analyzed. Patients were selected preoperatively according to predefined clinical, anesthetic, and social criteria and managed within a standardized Enhanced Recovery After Surgery–oriented pathway including morning scheduling, systematic early postoperative imaging, and structured telemedicine follow-up. Primary endpoints were failure of same-day discharge, surgery-related complications within 30 days, and unplanned hospital admission or consultation. Patient-reported satisfaction with ambulatory management was assessed by questionnaire. Among 606 supratentorial brain lesion resections performed during the study period, 40 (6.6%) were managed in a fully ambulatory setting. Same-day discharge was achieved in 39/40 procedures (97.5%); the single failure was related to metabolic decompensation of pre-existing diabetes. Within 30 days, 5/40 procedures (12.5%) were associated with postoperative complications: 3 transient neurological worsenings not requiring specific treatment (grade 1), 1 metabolic complication requiring overnight monitoring (grade 2), and 1 Guillain–Barré syndrome with persistent deficit (grade 3). The latter two were medical postoperative events not directly caused by the neurosurgical procedure itself. One patient (2.5%) required unplanned rehospitalization. No postoperative hematoma, seizure requiring emergent intervention, or death occurred. Among successfully managed outpatients, 97.2% reported being satisfied or very satisfied with ambulatory care, and 91.7% would choose the same pathway again. Fully ambulatory, home-to-home supratentorial craniotomy for intracerebral lesion resection is feasible and appears safe in a carefully selected European cohort, with high patient satisfaction. Although ambulatory cases still represent a small fraction of real-world brain tumor surgery, structured implementation of such pathways may help address current constraints on hospital beds and operating room capacity, while maintaining low complication and readmission rates, reducing overall costs, and improving patient-centered outcomes. Larger, multicenter studies in broader, real-world populations are warranted to refine selection criteria, quantify clinical and economic impact, and support wider adoption of ambulatory neurosurgery in routine practice.