Technical Aspects of Awake Craniotomy With Mapping for Brain Tumors in a Limited Resource Setting

BACKGROUND Brain tumor surgery near or within eloquent regions is increasingly common and is associated with a high risk of neurological injury. Awake craniotomy with mapping has been shown to be a valid method to preserve neurological function while increasing the extent of resection. However, the technique used varies greatly among centers. Most count on professionals such as neuropsychologists, speech therapists, neurophysiologists or neurologists to help in intraoperative patient evaluation. We describe our technique with the sole participation of neurosurgeons and anesthesiologists.

METHODS A retrospective review of 19 patients who underwent awake craniotomies for brain tumors between January 2013 and February 2017 at a tertiary university hospital was performed. We sought to identify and describe the most critical stages involved in this surgery as well as show the complications associated to our technique.

RESULTS Preoperative preparation, positioning, anesthesia, brain mapping, resection and management of seizures and pain were stages deemed relevant to the accomplishment of an awake craniotomy. Sixteen percent of the patients developed new post-operative deficit. Seizures occurred in 24%. None of them led to awake craniotomy failure.

CONCLUSIONS We provide a thorough description of the technique used in the awake craniotomies with mapping employed in our institution, where the intraoperative patient evaluation is carried out solely by neurosurgeons and anesthesiologists. The absence of other specialized personnel and equipment does not necessarily preclude successful mapping during awake craniotomy. Hopefully, we are providing helpful information for those who wish to offer function-guided tumor resection in their own centers.