Anaesthesia for awake craniotomy: A report of two cases in national hospital, Abuja

Abstract

Anaesthesia for neurosurgery while the patient remains awake requires a highly motivated patient and provision of high safety standard. Resection of brain tumours may cause neurological sequelae especially in the eloquent cortex depending on the site and size of tumour. Awake craniotomy which allows monitoring and mapping of the eloquent cortex is therefore a solution to this problem. This report of two cases of awake craniotomy done in National Hospital Abuja, Nigeria illustrates the procedure. The first patient is a 28year old man who had right fronto-parietal intra-axil tumour and underwent awake craniotomy under monitored anaesthesia care (MAC).

The second case is a 64year old man who had some neurological deficit from solitary brain metastasis from previously treated colonic adenocarcinoma. He was also a known hypertensive. He underwent awake craniotomy and excision of the solitary metastatic lesion. Both patients did well intraoperatively and postoperatively with monitored anaesthesia care.

Neurosurgery in awake patients could be challenging and it requires a dedicated and skilful anaesthetist, an experienced surgeon and a careful selection of appropriate patients. We report two cases of awake craniotomy done successfully under monitored anaesthesia care.

Keywords: Awake craniotomy, monitored anaesthesia care, neurosurgery, brain tumour