Experience of fully awake craniotomy for supratentorial lesions: a single-institution study

AIM In patients with poor medical conditions, awake procedures can help avoid the complications of general anesthesia. We aim to report and discuss our experience of awake craniotomy for the treatment of supratentorial lesions. MATERIAL AND METHODS We included patients who underwent awake craniotomy for supratentorial tumors between 2007 and 2018. A bipolar stimulation probe was used for patients with eloquent area lesions. The demographic features, presenting symptoms, comorbidities, localization, histopathology, pre- and postoperative Karnofsky performance status, mean operation length, mean length of hospital stay, and intraoperative and postoperative complications were recorded. RESULTS We included 250 patients (age, 53.5 ± 15.3 years; range, 15-90 years; 105 females and 145 males) mostly with metastasis (46%). The tumor resection rate was 90 ± 3.6%. Of 30 patients (12%) who experienced an increase in weakness, 26 experienced improvements within three days, and the remainder had permanent symptoms. Intraoperative and postoperative seizures occurred in three (1.2%) and seven (2.8%) patients, respectively, which were controlled by antiepileptic drugs. Dysphasia occurred intraoperatively in seven patients (2.8%) but improved in a month. The mean follow-up duration was 31.8 ± 11.9 months (range, 7-70 months). No mortality was seen during hospitalization. CONCLUSION Awake procedures are a good option in supratentorial lesions to avoid the complications of general anesthesia in patients with a poor medical condition. To obtain maximal tumor resection and maintain a patient\'s quality of life, neurosurgeons should opt for awake craniotomy often.