Question

Indications and contraindications of awake craniotomy.

Hint:

Awake craniotomy is particularly valuable for surgeries in brain regions responsible for vital functions like speech and movement.

Answer 1

Awake craniotomy is a procedure performed with the patient awake during parts of the surgery, allowing for real-time monitoring of brain functions.
Step 1: Indications:
1. Tumors Near Critical Brain Areas: Awake craniotomy is used for tumors located in areas that control language, motor functions, and other critical functions, to minimize damage to these areas.
2. Epilepsy Surgery: It is often used in patients with epilepsy, especially those with focal seizures, to map out seizure foci and avoid brain areas responsible for vital functions.
3. Brain Mapping: Awake craniotomy allows for direct cortical mapping and stimulation to help identify areas responsible for speech, motor functions, and sensory perception.
Step 2: Contraindications:
1. Uncooperative Patients: Awake craniotomy requires the patient to be awake and cooperative, so patients with cognitive impairments or who cannot follow instructions are not suitable candidates.
2. Severe Medical Conditions: Patients with significant comorbidities such as uncontrolled hypertension, bleeding disorders, or respiratory issues may not be candidates for awake craniotomy.
3. Tumors Inaccessible to Mapping: If the tumor is in a location that cannot be safely reached for mapping or resection, awake craniotomy may not be indicated.