Anesthesia for awake Craniotomy

Abstract

Anesthesia for awake craniotomy is a well tolerated procedure that requires an extensive knowledge of the principle underlying neuroanesthesia and of specific strategies including local anesthesia for scalp blockade, advanced airway management, dedicated sedation-analgesia protocols, and skillful management of hemodynamics . The traditional indication for awake craniotomy has been epilepsy surgery and, in particular, temporal lobectomy where the excision occasionally encroaches on the eloquent cortex (motor and speech areas). Tumour or arteriovenous malformation surgery where the lesion abuts or invades the speech, motor, sensory or visual cortex may also involve intraoperative functional testing or cortical mapping, requiring the patient to be awake Among the various needs are intraoperative and postoperative analgesia (induced with both local anesthesia and systemic sedation –analgesia),adequate ventilation,systemic and cerebral hemodynamic management,with no interference from electrophysiologic monitoring while mapping the area of surgical interest ,and full patient cooperation. These possibly conflicting targets sometimes makes the clinical practice of anesthesia for awake craniotomy a challenging and demanding task.