12. ANESTHESIA FOR AWAKE CRANIOTOMY CASE REPORT
Main Article Content
Abstract
Awake craniotomy combined with intraoperative electrophysiological monitoring helps to map the cerebral cortex, maximally removing the damaged brain area while preserving neurological function. For successful awake craniotomy, patient cooperation, pre- and intra-operative communication, and consensus among surgeons, anesthesiologists, and the OR staff are required. There is no recognized consensus on the best anaesthetic approach to an awake craniotomy. Based on the characteristics of each patient and surgery, we chose the Asleep-Awake-Asleep method for the surgery to remove the brain lesion causing epilepsy, and the Awake-Asleep method for the placement of deep brain stimulation. Scalp block plays an important role in pain management during awake craniotomy.
Article Details
Keywords
Awake craniotomy, IntraOperative NeuroMonitoring, brain mapping, epilepsy, deep brain stimulation.
References
[2] Chen G.B, Zhao Y.D, Xiao H.R, Li L, Sun D.J, Gao Y.H, Li Q.B, Chen H.H. A study of acupuncture anesthesia in surgery on the anterior cranial fossa. J Tradit Chin Med 1984 Sep, 4 (3): 189-96. PMID: 6570149.
[3] Chui Jason. Anesthesia for awake craniotomy: An update. Colombian Journal of Anesthesiology, 2025, 53 (3) p. 22-28.
[4] Ignacio Ladrero Paños, David Rivero Celada, Paula Jarén Cubillo, Cristina Bueno Fernández, Pedro Osorio Caicedo, Roberto Gomez Gomez. A Comparison of the Asleep-Awake Technique and Monitored Anesthesia Care During Awake Craniotomy: A 10-Year Analysis. Cureus, 2023 Dec 11, 15 (12): e50366. doi: 10.7759/cureus.50366
[5] Karampal Singh, Anterpreet Dua. Anesthesia for Awake Craniotomy. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2025 Jan PMID: 34283419. Bookshelf ID: NBK572053.
[6] Kareem Hussein, Michael Moore. Anaesthesia Management for Awake Craniotomy. Neuroanesthesia. Published November 1, 2022.
[7] Laura B Hemmer, Antoun Koht, Tod B Sloan. Neuromonitoring in surgery and anesthesia. UpToDate May 2025.
[8] Lingzhong Meng, David L McDonagh, Mitchel S Berger, Adrian W Gelb, MBChB. Anesthesia for awake craniotomy: a how-to guide for the occasional practitioner. 8 February 2017 Canadian Anesthesiologists’ Society 201.
[9] Nan Lin, Laszlo Vutskits, John F Bebawy, Adrian W Gelb. Perspectives on Dexmedetomidine Use for Neurosurgical Patients. J Neurosurg Anesthesiol, 2019 Oct 31, (4): 366-377. doi: 10.109 7/ANA.0000000000000554
[10] Daniele Natalini, Mario Ganau, Ruben Rosenkranz, Tatjana Petrinic, Karina Fitzgibbon, Massimo Antonelli, Lara Prisco. Comparison of the Asleep-Awake-Asleep Technique and Monitored Anesthesia Care During Awake Craniotomy: A Systematic Review and Meta-analysis. Journal of Neurosurgical Anesthesiology 34 (1): p. e1-e13. doi: 10.1097/ANA.0000000000000675
[11] Oumar Sacko, Valérie Lauwers-Cances, David Brauge, Musa Sesay, Adam Brenner, Franck-Emmanuel Roux. Awake craniotomy vs surgery under general anesthesia for resection of supratentorial lesions. Neurosurgery 2011 May, 68 (5): 1192-8, discussion 1198-9. doi: 10.1227/NEU.0b013e31820c02a3
[12] Martin Soehle, Christina F Wolf, Melanie J Priston, Georg Neuloh, Christian G Bien, Andreas Hoeft, Richard K Ellerkmann. Propofol Pharmacodynamics and Bispectral Index During Key Moments of Awake Craniotomy. Journal of Neurosurgical Anesthesiology, 2018, 30 (1), p. 32-38. doi: 10.1097/ANA.0000000000000378
[13] Takamasa Kayama. Guideline for awake surgery Neurol Med Chir (Tokyo), 2024 Jan 15, 64 (1): 1-27. doi: 10.2176/jns-nmc.2023-0111