Awake craniotomy for clipping of unruptured aneurysm: anesthesia concerns, management and challenges

Awake craniotomy is a neurosurgical technique performed either as an asleep-awake-asleep technique or a monitored anesthesia care technique, in combination with a scalp block. The surgery indication has been well documented for brain tumor excision at the eloquent cortex, epilepsy and deep brain stimulation surgery. However, this technique’s use during unruptured cerebral aneurysm clipping has only been recently reported. The main goal of awake craniotomy for unruptured cerebral aneurysm clipping is to prevent the risk of ischemia during temporary and permanent clipping by immediate awake neurological assessment during surgery. There have been limited reports on this surgery’s anesthesia issues. The aim of our case report is to discuss the anesthesia concerns, management and challenges during our first successful experience of this surgery. Key words: Awake craniotomy; Clipping; Cerebral aneurysm; Scalp block Citation: Hassan WMNW, Omar SC, Fui WT, Idris Z, Kandasamy R. Awake craniotomy for clipping of unruptured aneurysm: anesthesia concerns, management and challenges. Anaesth. pain intensive care 2021;25(1):96-101; DOI: 10.35975/apic.v25i1.1436 Received: 2 July 2020, Reviewed: 10 August 2020, Accepted: 3 September 2020