title: Awake craniotomy for brain tumours in Pakistan: An initial case series from a developing country.
abstract: Awake craniotomy offers safe resection of brain tumours in eloquent area. Aga Khan University Hospital, Karachi, recently started the programme in Pakistan, and the current study was planned to assess our experience of the first 16 procedures. The retrospective study comprised all such procedures done from November 2015 to May 2016. Pre-operative and post-operative variables were analysed. Of the 16 patients, 11(68.75%) were males and 5(31.25%) were females. The overall median age was 37 years (interquartile range[IQR]: 23-62 years). The most common presenting complaint was seizures 8(50%), followed by headache6(38%). The common pathologies operated include oligodendroglioma and glioblastoma. Pre-operative mean Karnofsky Performance Status score was 76±10, which increased to 96±7 post-operatively at discharge. Besides, 2(12.5%) intra-operative complications were observed, i.e. seizure and brain oedema, in the series. The study had median operative time of 176 minutes (IQR: 115-352) and median length of stay of 4 days (IQR: 3-7).Awake craniotomy was highly effective in maintaining post-operative functionality of the patient following glioma resection. It was also associated with shorter hospital course and so lower cost of management.
authors.affiliation: Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi.
authors.forename: Saad Akhtar
authors.initials: SA
authors.lastname: Khan
authors.affiliation: Medical College, Aga Khan University Hospital, Karachi.
authors.forename: Karim Rizwan
authors.initials: KR
authors.lastname: Nathani
authors.affiliation: Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi.
authors.forename: Badar Uddin
authors.initials: BU
authors.lastname: Ujjan
authors.affiliation: Department of Radiology, Aga Khan University Hospital, Karachi.
authors.forename: Muhammad Danish
authors.initials: MD
authors.lastname: Barakzai
authors.affiliation: Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi.
authors.forename: Syed Ather
authors.initials: SA
authors.lastname: Enam
authors.affiliation: Department of Anaesthesia, Aga Khan University Hospital, Karachi.
authors.forename: Faraz
authors.initials: F
authors.lastname: Shafiq
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000601:surgery*; D003399:Craniotomy; D003906:Developing Countries; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010154:Pakistan; D012189:Retrospective Studies; D055815:Young Adult
keywords: Awake craniotomy, Eloquent areas, Developing country, Postoperative deficits.