Teaching and sustainably implementing awake craniotomy in resource-poor settings.

Area of Science:

• Neurosurgery
• Global Health
• Surgical Education

Background:

• Awake craniotomy offers benefits like avoiding general anesthesia and reducing healthcare costs.
• Resource limitations in low- and middle-income countries (LMICs) hinder the adoption of awake craniotomy.
• There is a need to assess the feasibility of teaching and implementing awake craniotomy in LMICs.

Purpose of the Study:

• To determine if awake craniotomy can be safely and sustainably taught and implemented in LMICs.
• To evaluate the effectiveness of a training program for awake craniotomy in diverse global settings.

Main Methods:

• An experienced neurosurgeon trained local colleagues in awake craniotomy in China, Indonesia, Ghana, and Nigeria (2007-2012).
• Patient selection criteria included suspected intraaxial tumors and ability to tolerate positioning.
• Data collection focused on preoperative imaging, hospital stay, pathology, and postoperative outcomes.

Main Results:

• Awake craniotomy was performed in 38 suspected brain tumor cases, with most procedures completed independently.
• Hospital stays were less than 10 days for 64% of patients.
• No deaths occurred, and seizures were the most common issue, with one permanent deficit.

Conclusions:

• Awake craniotomy was successfully implemented in 6 neurosurgical centers across 4 countries.
• The procedure is safe, resource-sparing, and sustainable in resource-challenged environments.
• Awake craniotomy has the potential to significantly enhance access to neurosurgical care globally.