Awake Craniotomy: First year experience and patient perception

- BACKGROUND: Awake craniotomy for brain lesions in
or near eloquent brain regions enables neurosurgeons to
assess neurologic functions of patients intraoperatively,
reducing the risk of permanent neurologic deficits and
increasing the extent of resection.
- METHODS: A retrospective review was performed of a
consecutive series of patients with awake craniotomies in
the first year of their introduction to our tertiary
noneuniversity-affiliated neurosurgery department. Operation
time, complications, and neurologic outcome were
assessed, and patient perception of awake craniotomy was
surveyed using a mailed questionnaire.
- RESULTS: There were 24 awake craniotomies performed
in 22 patients for low-grade/high-grade gliomas, cavernomas,
and metastases (average 2 cases per month). Mean
operation timewas 205 minutes. Failure of awake craniotomy
because of intraoperative seizures with subsequent postictal
impaired testing or limited cooperation occurred in 2
patients. Transient neurologic deficits occurred in 29% of
patients; 1 patient sustained a permanent neurologic deficit.
Of the 18 patients (82%) who returned the questionnaire, only
2 patients recalled significant fear during surgery.
- CONCLUSIONS: Introducing awake craniotomy to a
tertiary noneuniversity-affiliated neurosurgery department
is feasible and resulted in reasonable operation times and
complication rates and high patient satisfaction.