Authors: Krismer L et al.
Journal of Neurosurgical Anesthesiology, November 5, 2025
DOI: 10.1097/ANA.0000000000001068
Summary
This study compared patient-reported experiences between two anesthesia strategies for awake craniotomy (AC): the traditional Asleep-Awake-Asleep (SAS) approach versus Monitored Anesthesia Care (MAC). SAS involves general anesthesia during the nonawake phases, while MAC relies on conscious sedation and spontaneous ventilation without airway instrumentation. Although both methods are considered safe and effective for tumor resections near eloquent brain areas, their subjective patient experience differences have been unclear.
A postoperative telephone survey was conducted for all eligible patients who underwent AC at a single institution between 2018 and 2024. SAS was used exclusively until late 2023 and MAC thereafter. The Beez interview protocol and the EQ-5D-5L tool assessed intraoperative experience and current quality of life. Operating room times were also evaluated.
Thirty-four patients completed the survey (17 SAS and 17 MAC). Baseline variables were largely comparable, except for a higher proportion of female patients in the SAS group. Patient reports revealed no meaningful difference in intraoperative experience or health-related quality of life between the two anesthetic strategies. However, MAC procedures were significantly shorter, averaging 366 minutes compared with 453 minutes for SAS.
Overall, both techniques provided similar patient perceptions of comfort, awareness, and postoperative well-being. MAC may offer workflow advantages through reduced total operating room time. The authors note that larger studies are needed to validate these findings.
What You Should Know
• Compared SAS vs MAC anesthesia for awake craniotomy using postoperative surveys.
• Patient-reported intraoperative experience was similar for both techniques.
• Postoperative quality of life also did not differ.
• MAC significantly shortened operating room time by nearly 90 minutes.
• No major differences aside from the time savings; both approaches were well tolerated.
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