Challenges During Anaesthesia for Awake Craniotomy

Abstract

Awake craniotomy enables the intra-operative assessment of a patient’s ­neurological status. This allows the safe mapping of resection margins in epilepsy surgery, the accurate localisation of electrodes for deep brain stimulation and the excision of space occupying lesions in eloquent cortex. Awake craniotomy is becoming more popular as it is associated with a lower requirement for high dependency care, shorter hospital stay and reduced costs. In tumour surgery, awake testing allows maximum resection with minimal post-operative neurological deficit. The anaesthetic techniques for awake craniotomy have evolved along with the surgical indications but significant challenges remain. The anaesthetic goals are the provision of adequate analgesia and sedation, with a safe airway, haemodynamic stability, ­optimal operating conditions and an alert, cooperative patient for intra-operative neurological assessment.