Department of Psychiatry, NYU Langone Health, New York City, New York, USA.
Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida, USA.
J Neurooncol. 2023 Sep;164(2):287-298. doi: 10.1007/s11060-023-04433-0. Epub 2023 Sep 12.
Awake craniotomy (AC) is a valuable technique for surgical interventions in eloquent areas, but its adoption in low- and middle-income countries faces challenges like limited infrastructure, trained personnel shortage, and inadequate funding. This scoping review explores AC techniques in Latin American countries, focusing on patient characteristics, tumor location, symptomatology, and outcomes.
A scoping review followed PRISMA guidelines, searching five databases in English, Spanish, and Portuguese. We included 28 studies with 258 patients (mean age: 43, range: 11-92). Patterns in AC use in Latin America were analyzed.
Most studies were from Brazil and Mexico (53.6%) and public institutions (70%). Low-grade gliomas were the most common lesions (55%), most of them located in the left hemisphere (52.3%) and frontal lobe (52.3%). Gross-total resection was achieved in 34.3% of cases. 62.9% used an Asleep-Awake-Asleep protocol, and 14.8% used Awake-Awake-Awake. The main complication was seizures (14.6%). Mean post-surgery discharge time was 68 h. Challenges included limited training, infrastructure, and instrumentation availability. Strategies discussed involve training in specialized centers, seeking sponsorships, applying for awards, and multidisciplinary collaborations with neuropsychology.
Improved accessibility to resources, infrastructure, and adequate instrumentation is crucial for wider AC availability in Latin America. Despite disparities, AC implementation with proper training and teamwork yields favorable outcomes in resource-limited centers. Efforts should focus on addressing challenges and promoting equitable access to this valuable surgical technique in the region.
清醒开颅术（AC）是在功能区进行手术干预的一项有价值的技术，但在中低收入国家，由于基础设施有限、缺乏训练有素的人员以及资金不足等挑战，该技术的应用受到限制。本范围综述探讨了拉丁美洲国家的 AC 技术，重点关注患者特征、肿瘤位置、症状和结果。
按照 PRISMA 指南进行范围综述，在英语、西班牙语和葡萄牙语的五个数据库中进行搜索。我们纳入了 28 项研究，共 258 名患者（平均年龄：43 岁，范围：11-92 岁）。分析了拉丁美洲 AC 使用模式。
大多数研究来自巴西和墨西哥（53.6%）和公共机构（70%）。低级别胶质瘤是最常见的病变（55%），其中大多数位于左半球（52.3%）和额叶（52.3%）。实现了 34.3%的大体全切除。62.9%使用了“睡眠-觉醒-睡眠”方案，14.8%使用了“觉醒-觉醒-觉醒”方案。主要并发症是癫痫发作（14.6%）。术后平均出院时间为 68 小时。面临的挑战包括培训、基础设施和仪器设备的可用性有限。讨论的策略包括在专门中心进行培训、寻求赞助、申请奖项以及与神经心理学的多学科合作。
改善资源、基础设施和适当仪器设备的可及性对于在拉丁美洲更广泛地提供 AC 至关重要。尽管存在差异，但在资源有限的中心，通过适当的培训和团队合作实施 AC 可获得良好的结果。应努力解决挑战，并在该地区促进公平获得这项有价值的手术技术。
