Background:
Awake glioma surgery in pregnant patient occurs rarely and is a huge challenge for the whole therapeutic team requiring cooperation of the neurosurgeon, the anesthesiologist, the speech therapist and the obstetrician.

Material and methods:
We present a case of a 31 year old patient in 22 hbd with low grade glioma (LGG) of the left temporal lobe.

Results:
Patient was admitted to an outpatient clinic with transient speech disorders for about a week. MRI revealed an extensive tumor in the left temporal region. Speech cortical centers were mapped with fMRI and the awake surgery was tailored. The surgery was performed under neuroleptoanalgesia with dexmedetomidine and remifentanil and regional anesthesia. The speech centers were located. Tumor was completely removed revealing astrocytoma fibrillare WHO II. Patient speech was continuously monitored, as well as the fetal vital functions. The course of pregnancy was uneventful. In the 48th month past first surgery, the patient underwent a reoperation due to tumor recurrence with consecutive protonotherapy. Currently, 88th months past first surgery, the patient and child stay both 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.