Awake craniotomy
Department of Neuroanaesthesia, The National Hospital for Neurology and Neurosurgery, London
Department of Neuroanaesthesia, Box 30, The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1 N 3BG
Tel: +020 78298711 Fax: +020 78298734 E-mail: martin.smith{at}uclh.org (for correspondence)
Anaesthetic techniques for awake craniotomy have been evolving over many years and include local anaesthesia and sedation or true asleep–awake–asleep techniques using general anaesthesia with intra-operative wake-up. The key advantage of awake techniques is the ability to assess the patient's neurological status during surgery, although this benefit has to be balanced against the loss of control of ventilation and assurance of immobility. However, the use of short-acting anaesthetic agents provide good operating conditions for the neurosurgeon whilst ensuring intraoperative cooperation from a comfortable patient. It is well tolerated by patients and minor procedures can be performed as a day case or with one overnight stay. The neuroanaesthetist plays a key role in the perioperative management of this challenging procedure.