Awake craniotomy in developing countries: review of hurdles

Abstract

Awake craniotomy is a neurosurgical approach, in which patient is operated under local anesthesia to assess his neurological function intraoperatively. It has multiple advantages over craniotomy under general anesthesia, mainly including improved postoperative neurological status, lower length of hospital, and lower overall cost of hospital stay. Awake craniotomy is commonly practiced in the developed world; however, its role in developing country is limited. Considering the benefits that awake craniotomy offers, it can contribute significant socioeconomic benefits to a developing country, especially with reduce expenditure on health care as well as maintenance of functional capacity of patients to continue work. Development of awake craniotomy in a developing country is a challenge. Multiple hurdles must be overcome before considering the possibility of the procedure. One of the key hurdles is limitation of resources. Others include neuroanesthesia training, extent of disease, and patient selection. Patient's awareness or literacy rate is also a factor to be considered, especially in developing countries where it can be difficult to explain the procedure to the patient. The authors have successfully implemented awake craniotomy in Pakistan recently and have shared how they managed to overcome the hurdles in their case. The hurdles are considerable, but they can be overcome with efforts. The program will be highly beneficial to a developing country and should be attempted for betterment of health-care facilities available to the population.