Interdisciplinary Neurosurgery (Sep 2020)
Awake craniotomy in neurosurgery: Shall we do it more often?
Abstract
Background: Awake craniotomy allows intraoperative cortical mapping to prevent injury to the eloquent brain region and minimizes the complications of general anaesthesia. The initial indications include epilepsy surgery and excision of diffuse glioma in eloquent brain region. There have been a remarkable development in the fields of neurosurgery and anaesthesia. Aim: To emphasis the role of awake craniotomy in lesions other than diffuse glioma. Method: Prospective review of awake craniotomies by the corresponding author over eighteen month’s period. We obtained consent for surgery as routine surgical procedure with emphasis on awake procedure to avoid the possible complications of general anaesthesia. Awake and cooperative patients with suitable lesion location in the brain convexity whose surgery were expected to last not more than four hours had awake craniotomies under scalp nerve block with local anaesthetic solution containing 0.5% xylocaine with adrenaline and 0.125% Bupivacaine. Results: Eight awake craniotomies were done within the period. The age range was 25–92 years. Male: female ratio was 1:1. There were three tumours, one intracerebral abscess, two acute subdural haematoma, a case of intracerebral haematoma secondary to ruptured AVM and craniotomy for removal of posterior left frontal intacerebral metallic object. There was no intraoperative seizures and there was no need to convert to general anaesthesia in any of the cases. A patient with intracerebral haematoma secondary to ruptured arteriovenous malformation (AVM) had excessive primary haemorrhage which was controlled. There was no neurological deficit or seizures and no incidence of wound infection. Conclusion: Awake craniotomy is beneficial in a variety of supratentorial brain lesions provided the patient comfort is not compromised. Awake craniotomy in suitable patients, will reduce the possible anaesthetic complications associated with general anaesthesia with endotracheal intubation and need for post-operative intensive care unit admission.
