Awake
craniotomy is becoming more popular as a neurosurgical technique that allows for increased
tumor resection and decreased postoperative neurologic morbidity. This technique, however, presents many challenges to both the neurosurgeon and anesthetist. An ASA class II, 37-year-old man with recurrent
oligodendroglioma presented for repeated
craniotomy. Prior
craniotomy under
general anesthesia resulted in residual
neurologic deficits. An awake
craniotomy was planned to allow for intraoperative testing for maximum
tumor resection and avoidance of neurologic morbidity. The patient was sedated with
propofol, and
bupivacaine was infiltrated for placement of Mayfield tongs and skin incision. Following exposure of brain tissue,
propofol infusion was discontinued to allow for patient cooperation during the procedure. Speech, motor, and sensory testing occurred during
tumor resection until resection stopped after onset of weakness in the right arm. The
propofol infusion was resumed while the cranium was closed and Mayfield tongs removed. The patient was awake, alert, oriented, and able to move all extremities but had residual weakness in the right forearm. Awake
craniotomy requires appropriate patient selection, knowledge of the surgeon's skill, and a thorough
anesthesia plan. This case report discusses the clinical and
anesthetic management for awake
craniotomy and reviews the literature.