Anaesthetic management of awake craniotomy in a patient with sick sinus syndrome: a case report

Abstract

Awake craniotomies (AC) have been mainly used in functional neurosurgery, tumour resection in eloquent regions, and epilepsy surgery. However, evidence of the practice of AC for other indications is scarce. Furthermore, there is limited evidence of AC performed on patients with severe comorbidities, especially those with poor cardiorespiratory reserve. We report a successful case of AC on a patient with bilateral acute on chronic subdural haemorrhage with sick sinus syndrome on a permanent pacemaker with multiple other comorbidities presenting for emergency bilateral burr hole and drainage. We were able to achieve a stable haemodynamic profile perioperatively with no untoward complications. The patient had improved neurological outcome immediately postoperatively that eliminated the need for close monitoring in ICU and allowed earlier hospital discharge.