الفهرس 
NEUROPHYSIOLOGYOnly 14 pages are availabe for public view
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Abstract
Forty patients ASA I, II aged 23-55 y harboring low grade glioma encroaching on
eloquent brain areas were included in this study. Twenty patients (group 1) received general
anesthesia with endotracheal intubation and controlled ventilation. In patients in the awake
group (group 2), scalp nerve block was done, local anesthetic infiltration at the site of skin
incision and the sites of pin insertion. Each site was infiltrated with 2-3 ml of a mixture of
bupivacaine 0.5%, lidocaine 1% and adrenaline 1:200000. All patients were monitored with
ECG, O2 saturation, invasive BP, temperature, and capnography (GA group). Respiratory
events (apnea, airway obstruction, O2 desaturation and hypercarbia), intracranial pressure
(ICP), seizures, neurological deficits, duration of hospital stay and ICU admission were
recorded for both groups. Results: None of the patients in the awake group received general
anesthesia. Two patients in the awake group developed intraoperative agitation that was
controlled by an extra sedative dose and five patients were oversedated. Despite that fourteen
patients in the awake group experienced intraoperative pain; it was severe in two patients that
required stopping surgery and giving more local anesthetic infiltration, and an extra dose of
propofol and fentanyl. None of the awake patients developed intraoperative nausea or
vomiting, while four patients in the GA group and one in awake group developed PONV and
this difference was statistically significant (p<0.05). Two patients in the awake group
developed intraoperative focal seizures and none of the patients had manifestations of local
anesthetic toxicity. Four patients in the awake group had subjective increased intracranial
tension (tense brain) as compared to six patents in the general anesthesia group. The
difference was not statistically significant (p=0.46). Postoperative ICU admission was higher
in patients in the general anesthesia group than in patients in the awake group (fourteen and
two patients respectively). The difference was statistically significant (p<0.001). Only two
patients in the awake group developed postoperative neurological dysfunction, as compared
with twelve patients the general anesthesia group. The difference was statistically significant
(p<0.001). The mean duration of hospital stay was 16.2 ± 3.69 days in the awake group.
It was 10.3 ± 3.66 days in the general anesthesia group. The difference was statistically
significant (p=0. 05). Conclusion: Awake craniotomy is a relatively simple procedure that
does not require sophisticated technology and allows tumor removal guided by physiology
rather than anatomy. Awake craniotomy has acceptable and easily manageable complications.
We believe that it can be applied to any tumor other than gliomas as long as eloquent areas
are concerned.