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Background: Awake neurosurgery is currently the mainstay for eloquent brain lesions. Opting for an awake operation is affected by a number of patient-related factors. We present a case of a patient with autistic spectrum disorder (ASD) that was successfully operated for a brain tumor through awake craniotomy. To the best of our knowledge, this is the first reported case in the literature. Case Description: A 42-year-old patient, with known ASD since his childhood, underwent awake craniotomy for a left supplementary motor area tumor. Detailed preoperative preparation of the patient was done to identify special requirements and establish a good patient-team relationship. Intraoperatively, continuous language and motor testing were performed. Conversation and music were the main distractors used. Throughout the operation, the patient remained calm and cooperative, even during a focal seizure. Mapping allowed for >80% resection of the tumor. Postoperatively, the patient recovered without any deficits. Conclusion: This case shows that with growing experience and meticulous preparation, the limits of awake craniotomy can be expanded to include more patients that were previously considered unfit.

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Summary A 52‐year‐old patient with hereditary haemorrhagic telangiectasia presented with profound epistaxis requiring surgery. The patient was at high risk of rebleeding into the airway after achieving surgical haemostasis. Remifentanil is known to facilitate smooth emergence from anaesthesia, particularly in situations where coughing or straining on a tracheal tube could exacerbate bleeding. Remifentanil would normally be commenced at induction of anaesthesia or immediately after induction. In this case, we descibe the management of such a patient using remifentanil only at the end of the operation, to facilitate a safe extubation.