A Case Report: Anaesthesia for Awake Craniotomy

Abstract

Background: Awake craniotomy is a neurosurgical technique that enables the precise localization of functional neural networks through intraoperative brain mapping and real-time monitoring. This operative method has been popularized in recent years due to decreased postoperative morbidities. We present a case of 31 years old female who was presented with episodes of generalized tonic colonic seizures. She had a history of recurring seizures occurring 2 to 3 times a week. Upon further investigations, she was diagnosed with brain space-occupying lesions initially suspected as low-grade glioma. Considering lesion site, the patient was deemed a suitable candidate for an awake craniotomy. To achieve conscious sedation, the patient received infusions of Remifentanil and Propofol at varying rates. During the procedure, the patient was under sedation and regularly tested for response to predetermined commands. The tumour was successfully excised by using a combination of local anaesthesia on the scalp and the administration of propofol and boluses through a systemic infusion. This case report highlights the importance of the team work among anaesthesia and surgeons where local /regional anaesthesia can be combined with sedation to perform a surgical procedure in certain conditions.