Initial Experience with Awake Craniotomy In Sudan

Abstract

Resection of brain tumours carries a great risk of functional impairment, especially if the tumour is located in the anterior temporal or frontal lobes, near motor, language, or memory areas of the brain. Awake craniotomy has been proposed aiming for maximum resection with minimum impairment of neurological function. The technique should provide adequate sedation, analgesia, respiratory and haemodynamic stability with an awake and cooperative patient for neurological testing. Airway management during a wake craniotomy is a crucial part of the anaesthetic technique, but it remains the subject of debate. In this case, who was the first patient operated upon as awake craniotomy in Sudan; awake craniotomy has been adopted as his cardiac function made surgery under general anaethesia a potential risk. The patient's tolerance to the procedure, haemodynamic stability, the incidence of airway obstruction and intraoperative and postoperative neurological status were assessed. The candidate well tolerated the procedure, with haemodynamic stability and a patent airway throughout the procedure. Convenient resection of the tumor was achieved and uneventful post-operative recovery with no neurological deficits was reported.

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

“…[41][42][43][44][45][46][47] All studies, except 4, reported AC on tumors only (78.9%). 22,23,26,29,31,32,[34][35][36][37][38][39][40] 1 study (5.3%) reported AC in epilepsy, 25 whereas 3 studies (15.8%) reported other surgical indications in addition to tumor 24,30,33 (Supplementary Table 3, http://links.lww.com/NEU/D712).…”

“…Eighteen studies (94.7%) reported the primary analgesic and sedation used in AC. [22][23][24][25][26][27][28][29][30][31][32][33][34][36][37][38][39][40] Propofol/fentanyl combination was used for sedation/ analgesia in 10 studies (52.6%) 22,24,[26][27][28][29][30][31]36,37 (Supplementary Table 3, http://links.lww.com/NEU/D712). Sixteen studies (84.2%) provided information on operation time.…”

“…Sixteen studies (84.2%) provided information on operation time. [22][23][24][25][26][27][28][30][31][32][34][35][36][37]39,40 The longest mean operation time was more than 237 minutes, 24 whereas the shortest operation time was 1 hour 33 (Supplementary Table 3, http://links.lww.com/NEU/D712).…”

“…Eighteen studies (94.7%) reported the primary analgesic and sedation used in AC. 22-34,36-40 Propofol/fentanyl combination was used for sedation/analgesia in 10 studies (52.6%) 22,24,26-31,36,37 ( Supplementary Table 3, http://links.lww.com/NEU/D712).…”

“…Thirteen studies (68.4%) specified the preoperative diagnostic imaging methods for localizing the lesions. 22,26,[28][29][30][31][33][34][35][36][37]39,40 MRI was the most common method used in 8 studies (42.1%) for preoperative localization, 26,31,[34][35][36][37]39,40 whereas computerized tomography (CT) and MRI were used in 4 studies (21.1%). 22,28,30,33 (Supplementary Table 4, http://links.lww.com/NEU/D713).…”