Awake craniotomy for intracranial lesions: An audit of the anaesthetists’ initial experience at the University College Hospital, Ibadan

Abstract

Background: Awake craniotomy (AC) is an attractive 'minimally invasive' anaesthetic technique for intracranial surgical procedures. There is dearth of information on the feasibility of this technique from developing countries. Material and methods: This is a prospective descriptive study on all the patients who had AC for intracranial surgery over a 2-year period in a developing country. The data regarding their demographics, preoperative, intraoperative and postoperative anaesthetic events and any intraoperative complications were recorded. Results: There were 18 patients, 11 (61.1%) males, mean age of 47.5 years (SD = 14.71). Propofol and Fentanyl were the sole agents providing conscious sedation during these surgical cases, while 0.25% Plain Bupivacaine and 1% Lidocaine with Adrenaline (1:200,000) were used for operative site anaesthesia. Most of the tumours, 7 (38.9%), were found in the parietal region of the brain; 9 (50.1%) patients had between 5 and 10 mm midline shift on brain MRI/CT Scan; metastatic tumours, 8 (44.4%), were the commonest lesions, and 13 (72.2%) had GCS of 15/15 prior to surgery. Hypertension and tachycardia, 3 cases (16.7%) in each, were the commonest intraoperative complications. All the patients successfully underwent the AC and none was admitted into the Intensive Care Unit postoperatively. At a mean follow-up of six months 10 (55.6%) patients were alive, 6 (33.3%) dead, and 2 (11.0%) of unknown status. Conclusions: This audit showed AC to be a well-tolerated procedure with low rate of complications in our practice, an encouraging prospect for the feasibility of AC for intracranial surgical procedures in developing countries.

Awake Craniotomy in Africa: A Scoping Review of Literature and Proposed Solutions to Tackle Challenges

“…Details of our search results are shown in Figure 1. Nineteen studies were included: 8 (42.1%) were from Egypt, 22-29 6 (31.6%) from Nigeria, 30-35 2 each (10.5%) from Sudan 36,37 and Morocco, 38,39 and 1 study (5.26%) was from South Africa 40 ( Supplementary Table 2, http://links.lww.com/NEU/D711). The intracontinental distribution of these studies is also schematically represented (Figure 2).…”

“…Elbakry et al 25 had the largest sample size, with 65 patients (16.4%), whereas the smallest sample size was in case-reports with 1 patient (0.25%) each. [34][35][36]38,40 Apart from 2 studies (10.5%) that had a mixture of adults and pediatric patients, 28,30 and 1 study (5.26%) that was on a child, 40 all other studies (84.2%) had adult patient populations. [22][23][24][25][26][27]29,[31][32][33][34][35][36][37][38][39] The youngest reported AC patient was 11 years old, 40 with the oldest being 92 years old, 33 demonstrating the accessibility of AC for a wide age range.…”

“…Sixteen studies (84.2%) clarified lesion types. 22,24,25,[28][29][30][31][32][33][34][35][36][37][38][39][40] Glioma in 120 patients (30.3%) was the most common, followed by epilepsy in 71 (17.9%) and nonglioma tumor in 36 (9.10%) (Table 2).…”

“…Nine studies (47.4%) reported the duration of hospitalization, 22,23,28,[30][31][32][33]39 with the longest being 5 to 11 days. 33 Notably, same-day discharge was reported for 2 patients 31 (Supplementary Table 4, http://links.lww.com/NEU/D713).…”

Simplifying the Technique of Awake Brain Surgery in a Condition of Less Equipped Neurosurgical Institution in Uzbekistan

“…Is There Hinderances to AC in Low-Resource Countries? [11][12][13][14][15][16][17][18][19] reported infrastructure limitations as an obstacle to performing AC operations with one study noting that lack of head pins at their hospital served as an obstacle to AC. 20 In our opinion, despite these constraints in technical and equipment facilities, awake surgery can be executed in LMIC settings.…”