Awake Craniotomy Procedure: Its Effects on Neurological Morbidity and Recommendations

To present our experience with the awake craniotomy (AC) method starting from the preoperative period, to report the morbidity and the functional outcomes along with the complications in patients who underwent AC, and to make recommendations for possible problems.

This study involved 46 cases- 2 of which were pediatric cases with lesions localized in the functional area - who were operated with the AC method between September 2011 and January 2016 at our clinic. The age range was 12 to 81 years. The average age was 48 years. Both preoperative and postoperative (1, 3, 6 and 12 months) neurological examinations were recorded.

Of the 46 patients who had AC surgery in this series, 17 were observed to have neurological deterioration in the intraoperative period. At the month 1 follow-up, 13 of these 17 patients were observed to have full neurological recovery. Moreover, 4 patients that developed hemiplegia were able to mobilize with support at the month 6 follow-up. All patients were observed to have a return of language skills to baseline preoperative function on month 1 follow-up.

When the results of the AC method were examined, it was observed that persistent postoperative neurological deficit rates were very low in the follow-up period. Based on our practice presented here, it could be concluded that the precise synchrony between the surgeon, the anesthesia team and the patient is required for successful AC and the preservation of language and motor functions.