title: Ethical challenges with awake craniotomy for tumor.
abstract: BACKGROUND
  Awake brain surgery is useful for the treatment of a number of conditions such as epilepsy and brain tumor, as well as in functional neurosurgery. Several studies have been published regarding clinical results and outcomes of patients who have undergone awake craniotomy but few have dealt with related ethical issues.
  
  
  OBJECTIVE
  The authors undertake to explore broadly the ethical issues surrounding awake brain surgery for tumor resection to encourage further consideration and discussion.
  
  
  METHODS
  Based on a review of the literature related to awake craniotomy and in part from the personal experience of the senior author, we conducted an assessment of the ethical issues associated with awake brain tumor surgery.
  
  
  RESULTS
  The major ethical issues identified relate to: (1) lack of data; (2) utilization; (3) conflict of interest; (4) informed consent; (5) surgical innovation; and (6) surgical training.
  
  
  CONCLUSIONS
  The authors respectfully suggest that the selection of patients for awake craniotomy needs to be monitored according to more consistent, objective standards in order to avoid conflicts of interest and potential harm to patients.
authors.affiliation: Division of Neurosurgery, Toronto Western Hospital, and Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, M5T 2S8, Canada.
authors.forename: Brandon
authors.initials: B
authors.lastname: Kirsch
authors.forename: Mark
authors.initials: M
authors.lastname: Bernstein
mesh_terms: D001294:Attitude to Health; D001932:Brain Neoplasms / Q000601:surgery*; D016265:Conflict of Interest; D003399:Craniotomy / Q000941:ethics* / Q000379:methods*; D006801:Humans; D010353:Patient Education as Topic; D018579:Patient Selection; D014851:Wakefulness