Awake craniotomy in low-resource settings: Findings from a retrospective cohort in the Philippines.

ABSTRACT Background Awake craniotomy is a technique used to maximize resection of lesions in eloquent areas of the brain while preserving function. While its use in high-income centers is well-documented for tumors and vascular lesions, reports of its use in low-middle income countries are limited. Of note, there are no published series yet from the Philippines. Methods We performed a retrospective review of all patients who underwent awake craniotomy at a tertiary referral center in Manila, Philippines from 2010 to 2019. Data on demographics, clinical features, diagnoses, intra- and post-operative complications, and outcomes were collected. Regression analyses was done to correlate use of intraoperative adjuncts with outcome measures (extent of resection, complication rate, neurologic status after surgery and on last follow-up, and in-hospital mortality). Results A total of 65 patients were included in the cohort, which had a male predilection (60%) and a mean age at diagnosis of 40.4 years. The most common indication was tumor excision (90%); followed by excision of arteriovenous malformations (5%) and cavernomas (3%). Of the tumors, the most common histopathologic diagnosis was low grade glioma (48%). The intraoperative complication rate was 13.8%, with the most common complication being patient intolerance. Gross total excision rate for tumors was 78.3%. Univariate analysis showed that use of a cortical stimulator was associated with improved neurologic status on last follow-up (p=0.0471). Conclusion Our experience shows that awake craniotomy is feasible in low-middle income country settings, and is safe and effective for excision of tumors, arteriovenous malformations, and cavernomas.