Explore the cutting-edge strategies proposed to overcome the notorious ‘steroid shift’ in neuronavigation, a pivotal step enhancing the precision of neurosurgical interventions.
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Simplifying the Technique of Awake Brain Surgery in a Condition of Less Equipped Neurosurgical Institution in Uzbekistan.
Mamadaliev et al., Asian J Neurosurg 2023
DOI: 10.1055/s-0043-1771326
Summary of Awake Craniotomy Protocol in LMICs
What’s New: This study introduces a simplified protocol for awake craniotomy (AC) tailored for low- and middle-income countries (LMICs) with limited resources, bypassing the need for expensive technologies like neuronavigation and intraoperative MRI.
Importance: AC is a critical neurosurgical procedure for tumor resection in eloquent brain areas, typically requiring costly equipment. This protocol demonstrates that AC can be effectively performed in resource-limited settings, potentially increasing accessibility to safe neurosurgical care in LMICs.
Contribution to Literature: The study contributes to the literature by providing evidence that AC can be successfully conducted without advanced technologies, which are often unavailable in LMICs. It emphasizes the use of basic intraoperative neurostimulation for brain mapping as a viable alternative.
Results: Out of 25 patients undergoing AC, near-total resection was achieved in 16 patients (69.5%), subtotal resection in 4 patients (17.39%), and partial resection in 3 patients (13.04%). Two patients required conversion to general anesthesia due to psychological instability. There was no mortality reported in the early or postoperative period.
Conclusion: The study confirms that AC can be performed with a minimum set of tools, preserving critical brain functions, and suggests that the absence of advanced technologies does not significantly compromise surgical outcomes in AC procedures.