Awake Craniotomy in Africa: A Scoping Review of Literature and Proposed Solutions to Tackle Challenges
Mohammad Mofatteh, Mohammad Sadegh Mashayekhi, Saman Arfaie, Amos O. Adeleye, Edward Jolayemi, Nathalie Ghomsi, Nathan A. Shlobin, Ahmed Morsy, Ignatius Esene, Tsegazeab Laeke, Ahmed K. Awad, Jason Labuschagne, Richard Ruan, Yared Nigusie Abebe, John N. Jabang, Abiodun Idowu Okunlola, Umaru Barrie, Hervé Monka Lekuya, Ehanga Idi Marcel, Kantenga Dieu Merci Kabulo, Nourou Dine Adeniran Bankolé, Idara Edem, Chibuikem A. Ikwuegbuenyi, Stéphane Nguembu, Yvan Zolo, Mark Bernstein
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.