Challenges During Anaesthesia for Awake Craniotomy

Abstract

The frequency and indications for awake craniotomy continue to increase. Its contemporary use began in the seventeenth century for the treatment of epilepsy, but it is now used for neuromodulation in the treatment of conditions such as Parkinson’s disease, tremor, dystonias, intractable headache and depression. It is also used extensively for tumours in eloquent cortex, where awake testing allows maximum resection with minimal post-operative neurological deficit. Awake craniotomy is associated with a lower requirement for high dependency care, shorter hospital stay and reduced costs, and it has been suggested that it could be used none selectively for the routine resection of tumours regardless of location. Currently a wide variety of anaesthetic management strategies are used none of which have been shown to be superior. The anaesthetic challenges are significant. The procedure has been shown to be safe and well tolerated, but careful patient selection is vital. Meticulous attention to detail and good communication are the keys to success.