Anesthetic Management of Awake Craniotomy for Cortical Mapping Near Broca's Area Using the Asleep-Awake-Asleep Technique: A Case Report

Abstract

Introduction: Awake craniotomy is a brain surgery technique performed while the patient is conscious, aimed at maximizing tumor resection while preserving neurological function, particularly when the lesion is located in eloquent areas such as the speech center or motor cortex. This technique combines regional anesthesia, selective sedation, and real-time intraoperative neurological monitoring. Case: A 35-year-old male presented with recurrent focal motor seizures in the right upper limb and mild cognitive disturbances. MRI revealed a lesion in the left frontal lobe near Broca’s area, suspected to be a low-grade glioma. The patient underwent awake craniotomy using the asleep–awake–asleep anesthesia technique, with a combination of propofol and dexmedetomidine, and a scalp block. During the awake phase, the patient was conscious, cooperative, and able to follow instructions for direct cortical mapping. No intraoperative complications such as seizures or airway obstruction occurred. Tumor resection was successfully completed with preservation of neurological function. Discussion: The combination of propofol and dexmedetomidine provided stable and cooperative sedation throughout the procedure, while the scalp block effectively reduced pain during cranial manipulation. Airway management with LMA and nasal oxygen maintained optimal oxygenation. Coordinated anesthetic strategy and precise neurological monitoring were key to the success of this awake craniotomy procedure. Conclusion: This case report presents the success of awake craniotomy at the cortical mapping location near Broca's area using the asleep-awake-asleep technique. The success of this approach depends on appropriate anesthetic techniques, cooperative sedation, and intraoperative neurophysiological monitoring.