Challenges and Prospects of Awake Craniotomy in a Resource-Poor Setting

Background: The trend in neurosurgery is towards awake craniotomy in a suitable patient to minimize the risk of anesthesia, allow intraoperative monitoring of the patient’s function and reduce operative morbidity. This has not been widely utilized in poor resource settings like our center where both human and material resources are limited. Aim: The aim of this review is to document the challenges and prospects of awake craniotomy in resource-poor settings. Methodology: The Federal Teaching Hospital Ido-Ekiti is located in a suburban community in South Western Nigeria with minimally active neurosurgical practice due to limited human and material resources. Two patients with right frontal brain tumor abutting on the motor cortex had awake craniotomy and gross total tumor excision under low dose sedation with propofol and local anesthesia. Results: Both patients complained of tolerable discomfort during bone work. We achieved a gross total tumor excision in both cases and there was no need to convert to general anesthesia. Both patients were fully awake at the end of their surgery and there was an improvement in their headache and hemiparesis. Conclusion: Awake craniotomy is commonly practiced in well-established neurosurgical facilities across the globe but it should be considered as an option in resource-poor settings in suitable patients to reduce operative morbidity and pressure on the limited human and material resources.