Abstract
An awake craniotomy is a continuously evolving technique used for the resection of brain tumours from the eloquent cortex. We report a 29-year-old male patient who presented to the Khoula Hospital, Muscat, Oman, in 2016 with a two month history of headaches and convulsions due to a space-occupying brain lesion in close proximity with the left motor cortex. An awake craniotomy was conducted using a scalp block, continuous dexmedetomidine infusion and a titrated ultra-low-dose of propofolfentanyl. The patient remained comfortable throughout the procedure and the intraoperative neuropsychological tests, brain mapping and tumour resection were successful. This case report suggests that dexmedetomidine in combination with titrated ultra-low-dose propofolfentanyl are effective options during an awake craniotomy, ensuring optimum sedation, minimal disinhibition and a rapid recovery. To the best of the authors' knowledge, this is the first awake craniotomy conducted successfully in Oman.
Highlights
Case ReportA 29-year-old man presented to the Khoula Hospital, Muscat, Oman, in 2016 with a two month history of headaches and convulsions
An awake craniotomy is a continuously evolving technique used for the resection of brain tumours from the eloquent cortex
We report a 29-year-old male patient who presented to the Khoula Hospital, Muscat, Oman, in 2016 with a two month history of headaches and convulsions due to a space-occupying brain lesion in close proximity with the left motor cortex
Summary
A 29-year-old man presented to the Khoula Hospital, Muscat, Oman, in 2016 with a two month history of headaches and convulsions. A: Coronal T2-weighted MRI showing a hyperintense left frontal intra-axial space-occupying lesion in the left superior frontal gyrus surrounded by oedema (arrow). Tomography scan of the brain revealed a left frontoparietal parafalcine lesion measuring 3.7 x 3.6 x 3.0 cm He was prescribed antiepileptics including dexamethasone and referred to the Khoula Hospital, a tertiary care neurosurgical centre. The patient was counselled by both a neurosurgeon and neuroanaesthesiologists and given a detailed explanation of the procedure, including the benefits and associated risks and the need for intraoperative neuropsychological testing. Histopathological analysis of the lesion revealed it to be an astrocytoma (World Health Organization grade II).[5]
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