Launching Awake Craniotomy Technique in a Resource-Limited Center: New Insights into the Patient Experience, Costs, and Long-Term Outcomes and a Narrative Review of the Literature.

BACKGROUND

Awake craniotomy (AC) with brain mapping is a standard surgical technique for the excision of lesions located in eloquent areas. We aimed to assess the clinical challenges, patient experience, costs, and long-term outcomes of AC in a resource-limited setting.

METHODS

In this cross-sectional study, electronic documents of 12 patients who underwent AC with functional brain mapping were prospectively collected from August 2017 to October 2020. Patient characteristics, surgical specifications, hospitalization period, intraoperative and postoperative events, functional outcome, patients' satisfaction, costs, and survivals were collected and analyzed.

RESULTS

Twelve patients with a median age of 42.5 (interquartile range, 13.5) were enrolled, of whom 8 were male (66.7%), and 9 (75%) were harboring grade 2 glioma. Of the patients, 8.34%, 33.34%, and 58.33% had partial, subtotal, and gross total excision of the tumors, respectively. The intraoperative seizure was the only complication and occurred in 2 cases (16.67%). At 1 year follow-up, none of the patients experienced any neurologic deficit. Eleven patients (91.6%) had a satisfactory opinion about reappearing in the AC. At 38 months follow-up, mortality was 8% for AC group and 25% among the historically matched controls who had surgery under general anesthesia (P = 0.27). Most costs belonged to the neurosurgery team (43%), and the overall expenses were reduced by 13% compared with a putatively well-equipped setting in our country.

CONCLUSIONS

In carefully selected individuals, AC with brain mapping for excision of gliomas could be a safe, effective, and affordable strategy in a resource-limited setting and can be successfully performed with satisfactory outcomes.