RESUMEN
@#Awake craniotomy has been gaining popularity for the last decade. It allowed maximum tumor resection while avoiding neurological morbidity. However, this technique presents several challenges to both the neurosurgeon and anesthesiologist. In this case, we present a 33-year-old male who was diagnosed with low-grade glioma in the left parieto-occipital, which required surgical resection. Anatomically, the tumor was located in the language area. Hence, it was decided to perform an awake craniotomy excision of the tumor to allow intraoperative cortical mapping to preserve language functions. Intraoperative, a subdural hematoma was noted, and severe pain occurred. Eventually, this leads to an upward herniation of the brain parenchyma. The crisis was addressed promptly with maneuvers to decrease intracranial pressure. Awake craniotomy was abandoned, and the procedure was converted to general anesthesia without the benefit of intraoperative cortical mapping. It is important to note that complications may arise during the procedure, leading to significant harm and debilitation for the patient. Prompt crisis management is necessary to address these potential issues and ensure the highest level of care is provided.
RESUMEN
@#Awake craniotomy is a neurosurgical technique that involves an awake neurological testing during the resection of an intracranial lesion in eloquent cerebral cortical areas representing motor, language, and speech. This technique is highlighted by an intra-operative cortical mapping that requires active participation by the patient and poses unique challenges to the anesthesiologist. The surgical and anesthetic techniques have evolved significantly over time, as the neurosurgeon and the anesthesiologist learn new steps in making this technique safe to achieve reasonable patient satisfaction. A thorough understanding of this surgical technique's rationale will guide the anesthesiologist in planning the anesthetic management depending on the surgery and neurologic testing. Constant communication between the neurosurgeon, anesthesiologist, and the patient will define this surgical technique's success. It is already a well-established procedure; however, factors that contribute to failures in awake craniotomy procedures have not been well characterized in the literature. Failure is defined as the inability to conduct awake neurologic testing during the awake craniotomy procedure because of various factors which will be described. This paper aims to review the challenges in the performance of three (3) cases of awake craniotomies performed in the Philippine General Hospital. The challenges described in these three (3) cases reveal that this can be experienced by the neurosurgeon, neuroanesthesiologist, and most especially the patient in an acute critical condition. Identification of the procedures' failure and the steps taken to manage such situations with the patient's safety in mind are discussed.