Anesthesia for Awake Neurosurgery

  • Antoun KohtEmail author
  • Georg Neuloh
  • Matthew C. Tate


Neurosurgical operations performed in awake patients are increasingly being used. Procedures employing this technique include resection of tumors and epileptic foci in and around the eloquent areas of the brain, localization of the proper nucleus for deep brain stimulation, testing for spinal cord stimulator placement and other pain procedures, carotid endarterectomy, and surgery on the spine and peripheral nervous system. Proponents cite easy neurological evaluation, short recovery, fewer complications, and early discharge from the hospital. In this chapter, we discuss the anesthetic management as well as monitoring the neurologic function during these procedures.


Anesthesia Monitoring Awake neurosurgery Awake craniotomy Craniotomy Tumor resection Indications Patient selection Sedation Analgesia Cortical mapping Subcortical mapping 

Supplementary material

Video 18.1

Blocking the supra trochlear nerve is done by inserting the needle perpendicular to the supratrochlear notch utilizing 25-gauge short needle to reach to the notch. After negative aspiration, 1 mL of local anesthetics is injected (MOV 2599 kb)

Video 18.2

Blocking the supraorbital nerve is done by inserting the needle perpendicular to the supraorbital notch utilizing 25-gauge short needle to reach to the notch. After negative aspiration 1 mL of local anesthetics is injected (MOV 1372 kb)

Video 18.3

The 25-gauge 38-mm-long needle is inserted just above the zygomatic arch two-thirds between the edge of orbit and the tragus. The needle is inserted to touch the temporal skull bone then to slide toward the orbit. Three milliliter of local anesthetics is injected closer to the orbit, 1 mL injected 1 cm lateral to the first inject followed by one more milliliter injected 1 cm more distal. (The 5 mL is injected only on the side of surgery; other side will be injected with 3-mL only) (MOV 5112 kb)

Video 18.4

This is a home-modified block [32]. Three milliliters of local anesthetics is injected 1 cm above the tragus just behind the superfacial temporal artery (MOV 2938 kb)

Video 18.5

The lesser occipital nerve is blocked behind the ear at a straight line from the tragus to the edge of the earlobe, in the groove behind the mastoid. Two milliliters injected at the groove and 1 mL superficial and anterior to the groove (MOV 2337 kb)

Video 18.6

First the occipital artery is palpated and the needle inserted medial to the artery to block the greater occipital nerve with 3 mL of local anesthetics (MOV 1734 kb)


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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Departments of Anesthesiology, Neurological Surgery and NeurologyNorthwestern University Feinberg School of MedicineChicagoUSA
  2. 2.Department of NeurosurgeryUniversity of AachenAachenGermany
  3. 3.Department of Neurological SurgeryNorthwestern Memorial HospitalChicagoUSA

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