Awake craniotomy: indications, benefits, and techniques

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Awake craniotomy is mainly used for mapping and resection of lesions in vitally important brain areas where imaging is not sufficiently sensitive. These are most commonly speech and motor areas. The awake approach has become increasingly popular with wider indications due to the advantage of better neurological and other perioperative outcomes including analgesia and postoperative nausea and vomiting. Improvements in anesthetic agents and techniques especially laryngeal mask airway have made a great contribution. Frequently used medications are propofol, dexmedetomidine, and remifentanil. Common anesthetic regimens range from light-moderate sedation, deep sedation, or general anesthesia during the pre-mapping and postmapping phases. In all sedation-anesthesia techniques, the patients are awake and able to speak and/or move during the mapping phase. This approach to intracranial surgical procedures requires skill, experience, and commitment on the part of the entire OR team. This review, from the point of view of authors, discusses the indications and contraindications, benefits, anesthetic techniques, challenges, and management, as well as potential future directions of awake craniotomy.

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