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. 2023 Aug 1;93(2):274-291.
doi: 10.1227/neu.0000000000002453. Epub 2023 Mar 24.

Awake Craniotomy in Africa: A Scoping Review of Literature and Proposed Solutions to Tackle Challenges

Mohammad Mofatteh  1 , Mohammad Sadegh Mashayekhi  2 , Saman Arfaie  1   3 , Amos Olufemi Adeleye  4 , Edward Olaoluwa Jolayemi  5 , Nathalie C Ghomsi  6 , Nathan A Shlobin  7 , Ahmed A Morsy  8 , Ignatius N Esene  9 , Tsegazeab Laeke  10 , Ahmed K Awad  11 , Jason J Labuschagne  12 , Richard Ruan  13 , Yared Nigusie Abebe  14 , John Nute Jabang  15 , Abiodun Idowu Okunlola  16 , Umaru Barrie  17 , Hervé Monka Lekuya  18 , Ehanga Idi Marcel  19 , Kantenga Dieu Merci Kabulo  20 , Nourou Dine Adeniran Bankole  21 , Idara J Edem  22 , Chibuikem A Ikwuegbuenyi  23 , Stephane Nguembu  24 , Yvan Zolo  25 , Mark Bernstein  26   27
Affiliations

Awake Craniotomy in Africa: A Scoping Review of Literature and Proposed Solutions to Tackle Challenges

Mohammad Mofatteh et al. Neurosurgery. .

Abstract

Background: Awake craniotomy (AC) is a common neurosurgical procedure for the resection of lesions in eloquent brain areas, which has the advantage of avoiding general anesthesia to reduce associated complications and costs. A significant resource limitation in low- and middle-income countries constrains the usage of AC.

Objective: To review the published literature on AC in African countries, identify challenges, and propose pragmatic solutions by practicing neurosurgeons in Africa.

Methods: We conducted a scoping review under Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Scoping Review guidelines across 3 databases (PubMed, Scopus, and Web of Science). English articles investigating AC in Africa were included.

Results: Nineteen studies consisting of 396 patients were included. Egypt was the most represented country with 8 studies (42.1%), followed by Nigeria with 6 records (31.6%). Glioma was the most common lesion type, corresponding to 120 of 396 patients (30.3%), followed by epilepsy in 71 patients (17.9%). Awake-awake-awake was the most common protocol used in 7 studies (36.8%). Sixteen studies (84.2%) contained adult patients. The youngest reported AC patient was 11 years old, whereas the oldest one was 92. Nine studies (47.4%) reported infrastructure limitations for performing AC, including the lack of funding, intraoperative monitoring equipment, imaging, medications, and limited human resources.

Conclusion: Despite many constraints, AC is being safely performed in low-resource settings. International collaborations among centers are a move forward, but adequate resources and management are essential to make AC an accessible procedure in many more African neurosurgical centers.

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Figures

FIGURE 1.
FIGURE 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Scoping Review flowchart demonstrating the search, screen, inclusion, and exclusion processes for this study.
FIGURE 2.
FIGURE 2.
The continental distribution of included studies. Egypt, Nigeria, Sudan, Morocco, and South Africa are colored, and the heatmap shows publication number per country.
FIGURE 3.
FIGURE 3.
A summary of challenges identified in representative African countries to perform safe AC. AC, awake craniotomy.
FIGURE 4.
FIGURE 4.
An overview of solutions suggested to tackle challenges associated with performing safe AC in different African countries. AC, awake craniotomy.
See this image and copyright information in PMC

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