Affordable Access

Publisher Website

Teaching and Sustainably Implementing Awake Craniotomy in Resource-Poor Settings

Elsevier Inc.
DOI: 10.1016/j.wneu.2013.07.003
  • Brain Tumor
  • Craniotomy
  • Education
  • Neurosurgery
  • World Health
  • Biology
  • Medicine


Objective Awake craniotomy for brain tumor resection has the benefit of avoiding a general anesthetic and decreasing associated costs (e.g., intensive care unit beds and intravenous line insertion). In low- and middle-income countries, significant resource limitations for the system and individual make awake craniotomy an ideal tool, yet it is infrequently used. We sought to determine if awake craniotomy could be effectively taught and implemented safely and sustainably in low- and middle-income countries. Methods A neurosurgeon experienced in the procedure taught awake craniotomy to colleagues in China, Indonesia, Ghana, and Nigeria during the period 2007–2012. Patients were selected on the basis of suspected intraaxial tumor, absence of major dysphasia or confusion, and ability to tolerate the positioning. Data were recorded by the local surgeons and included preoperative imaging, length of hospital admission, final pathology, postoperative morbidity, and mortality. Results Awake craniotomy was performed for 38 cases of suspected brain tumor; most procedures were completed independently. All patients underwent preoperative computed tomography or magnetic resonance imaging. In 64% of cases, patients remained in the hospital <10 days. The most common pathology was high-grade glioma, followed by meningioma, low-grade glioma, and metastasis. No deaths occurred, and no case required urgent intubation. The most common perioperative and postoperative issue was seizure, with 1 case of permanent postoperative deficit. Conclusions Awake craniotomy was successfully taught and implemented in 6 neurosurgical centers in China, Indonesia, Ghana, and Nigeria. Awake craniotomy is safe, resource-sparing, and sustainable. The data suggest awake craniotomy has the potential to significantly improve access to neurosurgical care in resource-challenged settings.

There are no comments yet on this publication. Be the first to share your thoughts.


Seen <100 times

More articles like this

An evolving model for training and education in re...

on The Medical Journal of Austral... Jan 06, 2003

Awake craniotomy

Jan 01, 2009

[Awake craniotomy].

on Anesteziologiia i reanimatolog... 2012
More articles like this..