Awake brain surgery in epilepsy: a case report and review of the literature

Abstract

Awake craniotomy is a frequent procedure in the practice of neurosurgery. In functional neurosurgery, this anesthetic technique has been described for Deep-Brain- Stimulators (DBS) placement in Parkinson’s disease and for tumor resection in eloquent areas. We describe a case of transoperative identification of epileptogenic foci with successful real-time resection. A 26-year-old patient who presented to our emergency room with seizures of difficult control despite a three-drug scheme. Brain image was performed that showed evidence of a left temporal lobe glioma. Due to the eloquent situation of the tumor, a resection under Awake-Sleep-Awake (AAA) technique was performed. Conclusion: Awake craniotomy is a very well stablished neurological procedure that has been increasing in frequency and indications. Profound knowledge of the perioperative and anesthetic management is key for the anesthesiologist to successfully perform the intricate procedure of managing the sleep and awake periods, as well as all its potential complications. Awake craniotomy allows for a very precise resection, having a positive impact in the short- and long-term quality of life of these patients.