Awake craniotomy: indications, benefits, and techniques

  • Kaiying Zhang Department of Anesthesiology, The University of Texas Health Science Center at Houston, Houston, USA.
  • Adrian W. Gelb Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, USA.
Keywords: Craniotomy, Intraoperative Awareness, Neurosurgery, Anesthesia, Monitoring, Physiologic


Awake craniotomy is mainly used for mapping and resection of lesions in vitally important brain areas where imaging is not sufficiently sensitive. These are most commonly speech and motor areas. The awake approach has become increasingly popular with wider indications due to the advantage of better neurological and other perioperative outcomes including analge sia and postoperative nausea and vomiting. Improvements in anesthetic agents and techniques especially LMA have made a great contribution. Frequently used medications are propofol, dexmedetomidine, and remifentanil. Common anesthetic regi mens range from light-moderate sedation, deep sedation, or general anesthesia during the pre-mapping and postmapping phases. In all sedation-anesthesia techniques, the patients are awake and able to speak and/or move during the mapping phase. This approach to intracranial surgical procedure requires skill, experience, and commitment on the part of the entire OR team. This review, from the point of view of authors, discusses the indications and contraindications, benefits, anesthetic techni ques, challenges, and management, as well as potential future directions of awake craniotomy.


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How to Cite
Zhang K, Gelb AW. Awake craniotomy: indications, benefits, and techniques. Colomb. J. Anesthesiol. [Internet]. 2018 Dec. 1 [cited 2024 May 25];46(Supplement):46-51. Available from:


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How to Cite
Zhang K, Gelb AW. Awake craniotomy: indications, benefits, and techniques. Colomb. J. Anesthesiol. [Internet]. 2018 Dec. 1 [cited 2024 May 25];46(Supplement):46-51. Available from:


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