title: Awake Craniotomy: First-Year Experiences and Patient Perception.
abstract: BACKGROUND
  Awake craniotomy for brain lesions in or near eloquent brain regions enables neurosurgeons to assess neurologic functions of patients intraoperatively, reducing the risk of permanent neurologic deficits and increasing the extent of resection.
  
  
  METHODS
  A retrospective review was performed of a consecutive series of patients with awake craniotomies in the first year of their introduction to our tertiary non-university-affiliated neurosurgery department. Operation time, complications, and neurologic outcome were assessed, and patient perception of awake craniotomy was surveyed using a mailed questionnaire.
  
  
  RESULTS
  There were 24 awake craniotomies performed in 22 patients for low-grade/high-grade gliomas, cavernomas, and metastases (average 2 cases per month). Mean operation time was 205 minutes. Failure of awake craniotomy because of intraoperative seizures with subsequent postictal impaired testing or limited cooperation occurred in 2 patients. Transient neurologic deficits occurred in 29% of patients; 1 patient sustained a permanent neurologic deficit. Of the 18 patients (82%) who returned the questionnaire, only 2 patients recalled significant fear during surgery.
  
  
  CONCLUSIONS
  Introducing awake craniotomy to a tertiary non-university-affiliated neurosurgery department is feasible and resulted in reasonable operation times and complication rates and high patient satisfaction.
authors.affiliation: Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: Holger
authors.initials: H
authors.lastname: Joswig
authors.affiliation: Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: Denis
authors.initials: D
authors.lastname: Bratelj
authors.affiliation: Department of Anesthesiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Brunner
authors.affiliation: Department of Anesthesiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: Alfred
authors.initials: A
authors.lastname: Jacomet
authors.affiliation: Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hildebrandt
authors.affiliation: Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland. Electronic address: surbeck.werner@gmail.com.
authors.forename: Werner
authors.initials: W
authors.lastname: Surbeck
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016292:Procedural Sedation / Q000523:psychology*; D003399:Craniotomy / Q000379:methods* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010865:Pilot Projects; D012189:Retrospective Studies; D055815:Young Adult
keywords: Awake craniotomy; Brain tumor; Cavernoma; Functional mapping; Glioma; Metastasis