Abstract
Abstract Awake craniotomy allows for patient participation in functional testing of eloquent cortical tissue in real-time intraoperatively. This allows for more extensive resections of tumor or ictal foci, providing the potential for better outcomes. The only absolute nonsurgical contraindication to awake craniotomy is patient refusal. Preoperative evaluation must include assessment of the patient’s anxiety, claustrophobia, risk of aspiration, and thorough evaluation of the airway (including risk of obstruction and likelihood of difficult mask ventilation or intubation). The two most common techniques for awake craniotomy are asleep-awake-asleep and monitored anesthesia care. Both approaches allow for sedation and analgesia during the craniotomy, alertness during intraoperative testing, and sedation during closure. Awake craniotomy limits exposure to general anesthesia. This allows for reduced postoperative nausea and vomiting as well as potentially lower costs by reducing hospital length of stay. Overall, awake craniotomy by either approach is well tolerated by the patient and should be considered the standard of care for resection of brain tumors in eloquent areas.
Published Version
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