Awake Craniotomy in Africa: A Scoping Review of Literature and Proposed Solutions to Tackle Challenges

Abstract

BACKGROUND: Awake craniotomy (AC) is a common neurosurgical procedure for the resection of lesions in eloquent brain areas, which has the advantage of avoiding general anesthesia to reduce associated complications and costs. A significant resource limitation in low- and middle-income countries constrains the usage of AC. OBJECTIVE: To review the published literature on AC in African countries, identify challenges, and propose pragmatic solutions by practicing neurosurgeons in Africa. METHODS: We conducted a scoping review under Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Scoping Review guidelines across 3 databases (PubMed, Scopus, and Web of Science). English articles investigating AC in Africa were included. RESULTS: Nineteen studies consisting of 396 patients were included. Egypt was the most represented country with 8 studies (42.1%), followed by Nigeria with 6 records (31.6%). Glioma was the most common lesion type, corresponding to 120 of 396 patients (30.3%), followed by epilepsy in 71 patients (17.9%). Awake-awake-awake was the most common protocol used in 7 studies (36.8%). Sixteen studies (84.2%) contained adult patients. The youngest reported AC patient was 11 years old, whereas the oldest one was 92. Nine studies (47.4%) reported infrastructure limitations for performing AC, including the lack of funding, intraoperative monitoring equipment, imaging, medications, and limited human resources. CONCLUSION: Despite many constraints, AC is being safely performed in low-resource settings. International collaborations among centers are a move forward, but adequate resources and management are essential to make AC an accessible procedure in many more African neurosurgical centers.

Anxiety and Depression in Pediatric-Onset Traumatic Spinal Cord Injury: A Systematic Review

“…Reduced functional independence was associated with anxiety and depression in studies reviewed. These ndings are consistent with studies on patients with other conditions, such as stroke [44], dementia [45], epilepsy [46], infectious diseases [47], traumatic brain injury [48], neurodegeneration [49], tumor [50][51][52], as well as the general healthy aging population [53][54][55], where higher stress, anxiety and depression were shown to be associated with lower functional independence and poorer outcomes. Indeed, a shorter duration of injury was associated with higher anxiety and depression.…”

Suicidal ideation and attempts in brain tumor patients and survivors: A systematic review

“…Data beyond North America and Europe would also be merited to assess such trends in other continents. 66 Last, concerning medical assistance in dying (MAiD) in brain tumor patients, there are differing opinions on its usage. 67 It was shown that many patients opting for MAiD were at advanced and palliative-stage cancer 68 ; however, brain tumor patients can be limited in their decision-making capacity.…”

Awake Craniotomy During Pregnancy: A Systematic Review of The Published Literature

“…Various strategies should be employed to support the physical and mental well-being of the patient to deliver a healthy and viable child. Indeed, AC has been shown to result in a lower psychological sequel for the patient, even in low-resource settings [21,55]. Furthermore, ethical considerations should be addressed regarding the well-being of the patient and maintenance of the pregnancy or preterm termination [61,62].…”

“…Multiple factors, including type, size, and location of the brain pathology, neurological symptoms, fetus age, and mother wellbeing should be considered before neurosurgical interventions during pregnancy. AC is associated with shorter hospitalization, fewer neurological de cits, improved psychological outcomes, and better prognosis and can be utilized in low-resource settings [21,55,56]. AC has been used for various surgical indications, including tumor [20,57], epilepsy [58, 59], and aneurysms [31] to enhance patients' outcomes [26,60].…”