Awake Craniotomy in Africa: A Scoping Review of Literature and Proposed Solutions to Tackle Challenges.
Journal
Neurosurgery
ISSN: 1524-4040
Titre abrégé: Neurosurgery
Pays: United States
ID NLM: 7802914
Informations de publication
Date de publication:
01 08 2023
01 08 2023
Historique:
received:
19
10
2022
accepted:
10
01
2023
pmc-release:
24
03
2024
medline:
19
7
2023
pubmed:
25
3
2023
entrez:
24
3
2023
Statut:
ppublish
Résumé
Awake craniotomy (AC) is a common neurosurgical procedure for the resection of lesions in eloquent brain areas, which has the advantage of avoiding general anesthesia to reduce associated complications and costs. A significant resource limitation in low- and middle-income countries constrains the usage of AC. To review the published literature on AC in African countries, identify challenges, and propose pragmatic solutions by practicing neurosurgeons in Africa. We conducted a scoping review under Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Scoping Review guidelines across 3 databases (PubMed, Scopus, and Web of Science). English articles investigating AC in Africa were included. Nineteen studies consisting of 396 patients were included. Egypt was the most represented country with 8 studies (42.1%), followed by Nigeria with 6 records (31.6%). Glioma was the most common lesion type, corresponding to 120 of 396 patients (30.3%), followed by epilepsy in 71 patients (17.9%). Awake-awake-awake was the most common protocol used in 7 studies (36.8%). Sixteen studies (84.2%) contained adult patients. The youngest reported AC patient was 11 years old, whereas the oldest one was 92. Nine studies (47.4%) reported infrastructure limitations for performing AC, including the lack of funding, intraoperative monitoring equipment, imaging, medications, and limited human resources. Despite many constraints, AC is being safely performed in low-resource settings. International collaborations among centers are a move forward, but adequate resources and management are essential to make AC an accessible procedure in many more African neurosurgical centers.
Sections du résumé
BACKGROUND
Awake craniotomy (AC) is a common neurosurgical procedure for the resection of lesions in eloquent brain areas, which has the advantage of avoiding general anesthesia to reduce associated complications and costs. A significant resource limitation in low- and middle-income countries constrains the usage of AC.
OBJECTIVE
To review the published literature on AC in African countries, identify challenges, and propose pragmatic solutions by practicing neurosurgeons in Africa.
METHODS
We conducted a scoping review under Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Scoping Review guidelines across 3 databases (PubMed, Scopus, and Web of Science). English articles investigating AC in Africa were included.
RESULTS
Nineteen studies consisting of 396 patients were included. Egypt was the most represented country with 8 studies (42.1%), followed by Nigeria with 6 records (31.6%). Glioma was the most common lesion type, corresponding to 120 of 396 patients (30.3%), followed by epilepsy in 71 patients (17.9%). Awake-awake-awake was the most common protocol used in 7 studies (36.8%). Sixteen studies (84.2%) contained adult patients. The youngest reported AC patient was 11 years old, whereas the oldest one was 92. Nine studies (47.4%) reported infrastructure limitations for performing AC, including the lack of funding, intraoperative monitoring equipment, imaging, medications, and limited human resources.
CONCLUSION
Despite many constraints, AC is being safely performed in low-resource settings. International collaborations among centers are a move forward, but adequate resources and management are essential to make AC an accessible procedure in many more African neurosurgical centers.
Identifiants
pubmed: 36961213
doi: 10.1227/neu.0000000000002453
pii: 00006123-202308000-00006
pmc: PMC10319364
doi:
Types de publication
Systematic Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
274-291Informations de copyright
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Congress of Neurological Surgeons.
Références
Dewan MC, Rattani A, Fieggen G, et al. Global neurosurgery: the current capacity and deficit in the provision of essential neurosurgical care. Executive summary of the global neurosurgery initiative at the program in global surgery and social change. J Neurosurg. 2019;130(4):1055-1064.
Abdelgadir J, Tran T, Muhindo A, et al. Estimating the cost of neurosurgical procedures in a low-income setting: an observational economic analysis. World Neurosurg. 2017;101:651-657.
Feigin VL, Nichols E, Alam T, et al. Global, regional, and national burden of neurological disorders, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(5):459-480.
Dziedzic T, Bernstein M. Awake craniotomy for brain tumor: indications, technique and benefits. Expert Rev Neurother. 2014;14(12):1405-1415.
Abdulrauf SI, Vuong P, Patel R, et al. “Awake” clipping of cerebral aneurysms: report of initial series. J Neurosurg. 2017;127(2):311-318.
Mulroy E, Robertson N, Macdonald L, Bok A, Simpson M. Patients' perioperative experience of awake deep-brain stimulation for Parkinson disease. World Neurosurg. 2017;105:526-528.
Minkin K, Gabrovski K, Karazapryanov P, et al. Awake epilepsy surgery in patients with focal cortical dysplasia. World Neurosurg. 2021;151:e257–264.
Taylor MD, Bernstein M. Awake craniotomy with brain mapping as the routine surgical approach to treating patients with supratentorial intraaxial tumors: a prospective trial of 200 cases. J Neurosurg. 1999;90(1):35-41.
Gravesteijn BY, Keizer ME, Vincent AJPE, Schouten JW, Stolker RJ, Klimek M. Awake craniotomy versus craniotomy under general anesthesia for the surgical treatment of insular glioma: choices and outcomes. Neurol Res. 2018;40(2):87-96.
Bojaxhi E, Louie C, ReFaey K, et al. Reduced pain and opioid use in the early postoperative period in patients undergoing a frontotemporal craniotomy under regional vs general anesthesia. World Neurosurg. 2021;150:e31–37.
July J, Manninen P, Lai J, Yao Z, Bernstein M. The history of awake craniotomy for brain tumor and its spread into Asia. Surg Neurol. 2009;71(5):621-624. discussion 624-5.
Martino J, Gomez E, Bilbao JL, Dueñas JC, Vázquez-Barquero A. Cost-utility of maximal safe resection of WHO grade II gliomas within eloquent areas. Acta Neurochir. 2013;155(1):41-50.
Howe KL, Zhou G, July J, et al. Teaching and sustainably implementing awake craniotomy in resource-poor settings. World Neurosurg. 2013;80(6):e171–174.
Hall S, Kabwama S, Sadek A-R, et al. Awake craniotomy for tumour resection: the safety and feasibility of a simple technique. Interdiscip Neurosurg. 2021;24:101070.
Hervey-Jumper SL, Li J, Lau D, et al. Awake craniotomy to maximize glioma resection: methods and technical nuances over a 27-year period. J Neurosurg. 2015;123(2):325-339.
Vanacôr C, Duffau H. Analysis of legal, cultural, and socioeconomic parameters in low-grade glioma management: variability across countries and implications for awake surgery. World Neurosurg. 2018;120:47-53.
Serletis D, Bernstein M. Prospective study of awake craniotomy used routinely and nonselectively for supratentorial tumors. J Neurosurg. 2007;107(1):1-6.
Mansur A, Oswari S, Perdana Wahjoepramono PO, Kusdiansah M, Bernstein M. Awake craniotomy in a low- to middle-income country: a sustainability analysis. World Neurosurg. 2018;37(4):332-341.
Ooi SZY, de Koning R, Egiz A, et al. Management and outcomes of low-grade gliomas in Africa: a scoping review. Ann Med Surg. 2022;74:103246.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Plos Med. 2009;6(7):e1000097.
Adeleye AO, Idowu OK, Ghadirpour R, Iaccarino C. Minicraniotomy under local anesthesia and monitored sedation for the operative treatment of uncomplicated traumatic acute extradural hematoma. World Neurosurg. 2020;142:513-519.
Ali MZ, Fadel NA, Abouldahab HA. Awake craniotomy versus general anesthesia for managing eloquent cortex low-grade gliomas. Neurosciences (Riyadh) 2009;14(3):263-272.
Abdou SA, Shehab HA, Samir EM, Eissa EM. Preliminary evaluation of ketofol-based sedation for awake craniotomy procedures. Egypt J Anaesth. 2010;26(4):293-297.
Aboeldahab H, Hegazy A, Salah A, Tarif T. Is the usage of mannitol mandatory in awake craniotomy? A comparative study. Egypt J Anaesth. 2011;27(1):39-44.
Elbakry AE, Ibrahim E. Propofol-dexmedetomidine versus propofol-remifentanil conscious sedation for awake craniotomy during epilepsy surgery. Minerva Anestesiol. 2017;83(12):1248-1254.
Waly S, Nasr Y, Morsy A. Quasi-experiment as an initial experience for conscious sedation in awake craniotomy: dexmedetomidine versus midazolam. Res Opin Anesth Intensive Care 2020;7(1):31.
Nasr YM, Waly SH, Morsy AA. Scalp block for awake craniotomy: lidocaine-bupivacaine versus lidocaine-bupivacaine with adjuvants. Egypt J Anaesth. 2020;36(1):7-15.
Abdelhameed E, Abdelghany MS, Abdelkhalek H, Elatrozy HIS. Awake surgery for lesions near eloquent brain under scalp block and clinical monitoring: experience of single center with limited resources. Egypt J Neurol Psychiatry Neurosurg. 2021;57(1):78.
Morsy AA, Ismail AM, Nasr YM, Waly SH, Abdelhameed EA. Predictors of stimulation-induced seizures during perirolandic glioma resection using intraoperative mapping techniques. Surg Neurol Int. 2021;12:117.
Idowu OK, Adeleye AO, Amanor-Boadu SD. Awake craniotomy for intracranial lesions: an audit of the anaesthetists’ initial experience at the University College Hospital, Ibadan. Egypt J Anaesth. 2016;32(4):559-564.
Balogun JA, Idowu OK, Malomo AO. Challenging the myth of outpatient craniotomy for brain tumor in a Sub-Saharan African setting: a case series of two patients in Ibadan, Nigeria. Surg Neurol Int. 2019;10:71-76.
Okunlola A, Okunlola C, Babalola O, et al. Challenges and Prospects of Awake Craniotomy in a Resource-Poor Setting; 2019.Refstyled.
Okunlola AI, Babalola OF, Okunlola CK, Akinmade A, Abiola P, Orewole TO. Awake craniotomy in neurosurgery: shall we do it more often?. Interdiscip Neurosurg. 2020;21:100770.
Okunlola AI. Awake craniotomy in a Covid-19 positive patient: the challenges and outcome. Interdiscip Neurosurg. 2021;24:101064.
Okunlola AI, Ibijola AA, Babalola OF, Okunlola CK, Erinomo OO. Parasagittal cystic meningioma mimicking hemangioblastoma: a case report. Surg Neurol Int. 2021;12:368.
Mohamed H, Arbab M, Aldeaf S. Initial experience with awake craniotomy in Sudan. Sudan J Med Sci. 2008;3(2):171-175.
Mohamed H, Mohamed M, Mohaned A, Arbab M, Salim A, Aldeaf S. Awake craniotomy, an unusual indication. J Neurol Neurosci. 2013;4(3):1-7.
Meziane M, Elkoundi A, Ahtil R, Guazaz M, Mustapha B, Haimeur C. Anaesthetic management for awake craniotomy in brain glioma resection: initial experience in Military Hospital Mohamed V of Rabat. Pan Afr Med J. 2017;27:156.
Benyaich Z, Hajhouji F, Laghmari M, et al. Awake craniotomy with functional mapping for glioma resection in a limited-resource-setting: preliminary experience from a lower-middle income country. World Neurosurg. 2020;139:200-207.
Labuschagne J, Lee CA, Mutyaba D, Mbanje T, Sibanda C. Awake craniotomy in a child: assessment of eligibility with a simulated theatre experience. Case Rep Anesthesiol. 2020;2020:1-5.
Sills AK. Current treatment approaches to surgery for brain metastases. Neurosurgery 2005;57(5):S24-S32. discusssion S1-4.
Matsuda R, Coello AF, De Benedictis A, Martinoni M, Duffau H. Awake mapping for resection of cavernous angioma and surrounding gliosis in the left dominant hemisphere: surgical technique and functional results: clinical article. J Neurosurg. 2012;117(6):1076-1081.
Gonen T, Sela G, Yanakee R, Ram Z, Grossman R. Surgery-independent language function decline in patients undergoing awake craniotomy. World Neurosurg. 2017;99:674-679.
Chua TH, See AAQ, Ang BT, King NKK. Awake craniotomy for resection of brain metastases: a systematic review. World Neurosurg. 2018;120:e1128–e1135.
Sitnikov AR, Grigoryan YA, Mishnyakova LP. Awake craniotomy without sedation in treatment of patients with lesional epilepsy. Surg Neurol Int. 2018;9(1):177.
Domingo RA, Vivas-Buitrago T, Sabsevitz DS, Middlebrooks EH, Quinones-Hinojosa A. Awake craniotomy with cortical and subcortical speech mapping for supramarginal cavernoma resection. World Neurosurg. 2020;141:260.
Wang AT, Pillai P, Guran E, et al. Anesthetic management of awake craniotomy for resection of the language and motor cortex vascular malformations. World Neurosurg. 2020;143:e136–148.
Goettel N, Bharadwaj S, Venkatraghavan L, Mehta J, Bernstein M, Manninen PH. Dexmedetomidine vs propofol-remifentanil conscious sedation for awake craniotomy: a prospective randomized controlled trial † †Euroanaesthesia Congress, May 31, 2015, Berlin, Germany, and Canadian Anesthesiologists’ Society Annual Meeting, June 20, 2015, Ottawa, Canada. ‡ ‡This Article is accompanied by Editorial Aew113. Br J Anaesth. 2016;116(6):811-821.
Prontera A, Baroni S, Marudi A, et al. Awake craniotomy anesthetic management using dexmedetomidine, propofol, and remifentanil. Drug Des Dev Ther. 2017;11:593-598.
McAuliffe N, Nicholson S, Rigamonti A, et al. Awake craniotomy using dexmedetomidine and scalp blocks: a retrospective cohort study. Can J Anesth. 2018;65(10):1129-1137.
Grill J, Viguier D, Kieffer V, et al. Critical risk factors for intellectual impairment in children with posterior fossa tumors: the role of cerebellar damage. J Neurosurg Pediatr. 2004;101(2):152-158.
Delion M, Terminassian A, Lehousse T, et al. Specificities of awake craniotomy and brain mapping in children for resection of supratentorial tumors in the language area. World Neurosurg. 2015;84(6):1645-1652.
Pallud J, Dezamis E. Functional and oncological outcomes following awake surgical resection using intraoperative cortico-subcortical functional mapping for supratentorial gliomas located in eloquent areas. Neurochirurgie 2017;63(3):208-218.
McGirt MJ, Chaichana KL, Attenello FJ, et al. Extent of surgical resection is independently associated with survival in patients with hemispheric infiltrating low-grade gliomas. Neurosurgery 2008;63(4):700-708. author reply 707-8.
Sacko O, Lauwers-Cances V, Brauge D, Sesay M, Brenner A, Roux FE. Awake craniotomy vs surgery under general anesthesia for resection of supratentorial lesions. Neurosurgery 2011;68(5):1192-1199. discussion 1198-9.
Gerritsen JKW, Viëtor CL, Rizopoulos D, et al. Awake craniotomy versus craniotomy under general anesthesia without surgery adjuncts for supratentorial glioblastoma in eloquent areas: a retrospective matched case-control study. Acta Neurochir. 2019;161(2):307-315.
Mahon BZ, Miozzo M, Pilcher WH. Direct electrical stimulation mapping of cognitive functions in the human brain. Cogn Neuropsychol. 2019;36(3-4):97-102.
Roux FE, Boulanouar K, Lotterie JA, Mejdoubi M, LeSage JP, Berry I. Language functional magnetic resonance imaging in preoperative assessment of language areas: correlation with direct cortical stimulation. Neurosurgery 2003;52(6):1335-1347; discussion 1345-7.
Nossek E, Matot I, Shahar T, et al. Intraoperative seizures during awake craniotomy: incidence and consequences: analysis of 477 patients. Neurosurgery 2013;73(1):135-140. ; discussion 140.
Gernsback JE, Kolcun JPG, Starke RM, Ivan ME, Komotar RJ. Who needs sleep? An analysis of patient tolerance in awake craniotomy. World Neurosurg. 2018;118:e842–848.
Sader E, Yee P, Hodaie M. Assessing barriers to neurosurgical care in sub-saharan africa: the role of resources and infrastructure. World Neurosurg. 2017;98:682-688.e3.
Sewell D, Smith M. Awake craniotomy: anesthetic considerations based on outcome evidence. Curr Opin Anaesthesiol. 2019;32(5):546-552.
Bramall A, Djimbaye H, Tolessa C, Biluts H, Abebe M, Bernstein M. Attitudes toward neurosurgery in a low-income country: a qualitative study. World Neurosurg. 2014;82(5):560-566.
Kissani N, Cherkaoui Rhazouani O, Souirti Z, et al. Epilepsy in Morocco: realities, pitfalls and prospects. Epilepsia Open 2021;6(1):13-21.
Ogbole GI, Adeyomoye AO, Badu-Peprah A, Mensah Y, Nzeh DA. Survey of magnetic resonance imaging availability in West Africa. Pan Afr Med J. 2018;30:240.
Turel MK, Bernstein M. Outpatient neurosurgery. Expert Rev Neurother. 2016;16(4):425-436.
Nassiri F, Li L, Badhiwala JH, et al. Hospital costs associated with inpatient versus outpatient awake craniotomy for resection of brain tumors. J Clin Neurosci. 2019;59:162-166.
Mofatteh M, Mashayekhi MS, Arfaie S, et al. Stress, anxiety, and depression associated with awake craniotomy: a systematic review. Neurosurgery 2022;92(2):225-240.
Blanshard HJ, Chung F, Manninen PH, Taylor MD, Bernstein M. Awake craniotomy for removal of intracranial tumor: considerations for early discharge. Anesth Analg. 2001;92(1):89-94.
Thomas JG, Gadgil N, Samson SL, Takashima M, Yoshor D. Prospective trial of a short hospital stay protocol after endoscopic endonasal pituitary adenoma surgery. World Neurosurg. 2014;81(3-4):576-583.
Sughrue ME, Bonney PA, Choi L, Teo C. Early discharge after surgery for intra-axial brain tumors. World Neurosurg. 2015;84(2):505-510.
Enam S, Khan S, Nathani K, Shafiq F. Awake craniotomy in developing countries: review of hurdles. IJS Short Rep. 2017;2(1):5.
Beauregard CL, Friedman WA. Routine use of postoperative ICU care for elective craniotomy: a cost-benefit analysis. Surg Neurol. 2003;60(6):483-489. dicussion 489.
Rhondali O, Genty C, Halle C, et al. Do patients still require admission to an intensive care unit after elective craniotomy for brain surgery?. J Neurosurg Anesthesiol. 2011;23(2):118-123.
Uche EO, Ezomike UO, Chukwu JC, Ituen MA. Intensive care unit admissions in Federal Medical Centre Umuahia south east Nigeria. Niger J Med. 2012;21(1):70-73.
Vukoja M, Riviello E, Gavrilovic S, et al. A survey on critical care resources and practices in low- and middle-income countries. Glob Heart 2014;9(3):337-342. e1-5.
Quimby AE, Shamy MCF, Rothwell DM, Liu EY, Dowlatshahi D, Stotts G. A novel neuroscience intermediate-level care unit model: retrospective analysis of impact on patient flow and safety. Neurohospitalist 2017;7(2):83-90.
Peruzzi P, Bergese SD, Viloria A, Puente EG, Abdel-Rasoul M, Chiocca EA. A retrospective cohort-matched comparison of conscious sedation versus general anesthesia for supratentorial glioma resection. Clinical article. J Neurosurg. 2011;114(3):633-639.
Brown T, Shah AH, Bregy A, et al. Awake craniotomy for brain tumor resection: the rule rather than the exception?. J Neurosurg Anesthesiol. 2013;25(3):240-247.
Bernstein M. Outpatient craniotomy for brain tumor: a pilot feasibility study in 46 patients. Can J Neurol Sci. 2001;28(2):120-124.
Boulton M, Bernstein M. Outpatient brain tumor surgery: innovation in surgical neurooncology. J Neurosurg. 2008;108(4):649-654.
Carrabba G, Venkatraghavan L, Bernstein M. Day surgery awake craniotomy for removing brain tumours: technical note describing a simple protocol. Minim Invasive Neurosurg. 2008;51(04):208-210.
Grundy PL, Weidmann C, Bernstein M. Day-case neurosurgery for brain tumours: the early United Kingdom experience. Br J Neurosurg. 2008;22(3):360-367.
Pascual JSG, Duffau H. The need to consider return to work as a main outcome in patients undergoing surgery for diffuse low-grade glioma: a systematic review. Acta Neurochir. 2022;164(10):2789-2809.
You H, Qiao H. Intraoperative neuromonitoring during resection of gliomas involving eloquent areas. Front Neurol. 2021;12:658680.
Lavrador JP, Gioti I, Hoppe S, et al. Altered motor excitability in patients with diffuse gliomas involving motor eloquent areas: the impact of tumor grading. Neurosurgery 2021;88(1):183-192.
Lavrador JP, Ghimire P, Brogna C, et al. Pre- and intraoperative mapping for tumors in the primary motor cortex: decision-making process in surgical resection. J Neurol Surg A Cent Eur Neurosurg. 2021;82(04):333-343.
Keeble H, Lavrador JP, Pereira N, et al. Electromagnetic navigation systems and intraoperative neuromonitoring: reliability and feasibility study. Oper Neurosurg. 2021;20(4):373-382.
Duffau H, Lopes M, Arthuis F, et al. Contribution of intraoperative electrical stimulations in surgery of low grade gliomas: a comparative study between two series without (1985-96) and with (1996-2003) functional mapping in the same institution. J Neurol Neurosurg Psychiatry. 2005;76(6):845.
Trebuchon A, Guye M, Tcherniack V, Tramoni E, Bruder N, Metellus P. Intérêt du monitoring électrophysiologique au cours d’une chirurgie éveillée en neurochirurgie. Ann Françaises d'Anesthésie de Réanimation 2012;31(6):e87–90.
Saito T, Tamura M, Chernov MF, Ikuta S, Muragaki Y, Maruyama T. Neurophysiological monitoring and awake craniotomy for resection of intracranial gliomas. Prog Neurol Surg. 2018;30:117-158.
Mofatteh M. Neurosurgery and artificial intelligence. AIMS Neurosci. 2021;8(4):477-495.
Mofatteh M, Mashayekhi MS, Arfaie S, et al. Augmented and virtual reality usage in awake craniotomy: a systematic review. Neurosurg Rev. 2022;46(1):19.
Trimble G, McStravick C, Farling P, et al. Awake craniotomy for glioma resection: technical aspects and initial results in a single institution. Br J Neurosurg. 2015;29(6):836-842.
Leal RTM, Barcellos BM, Landeiro JA. Technical aspects of awake craniotomy with mapping for brain tumors in a limited resource setting. World Neurosurg. 2018;113:67-72.
Kim SS, McCutcheon IE, Suki D, et al. Awake craniotomy for brain tumors near eloquent cortex: correlation of intraoperative cortical mapping with neurological outcomes in 309 consecutive patients. Neurosurgery 2009;64(5):836-846. ; discussion 345-6.
Blankstein U, Dakurah T, Bagan M, Hodaie M. Structured online neurosurgical education as a novel method of education delivery in the developing World. World Neurosurg. 2011;76(3-4):224-230.
Cadotte DW, Sedney C, Djimbaye H, Bernstein M. A qualitative assessment of the benefits and challenges of international neurosurgical teaching collaboration in Ethiopia. World Neurosurg. 2014;82(6):980-986.
Fallah PN, Bernstein M. Unifying a fragmented effort: a qualitative framework for improving international surgical teaching collaborations. Global Health 2017;13(1):70.