Awake Surgery for Lesional Epilepsy in Resource-Limited Settings: Case Report and Review of Literature
- Author:
Mohammad Hamza BAJWA
1
;
Syeda Amrah HASHMI
;
Abdullah NISAR
;
Muhammad Waqas BAQAI
;
Saqib Kamran BAKHSHI
;
Muskaan Abdul QADIR
;
Faraz SHAFIQ
;
Syed Ather ENAM
Author Information
- Publication Type:CASE REPORT
- From:Brain Tumor Research and Treatment 2023;11(4):289-294
- CountryRepublic of Korea
- Language:English
- Abstract: Epilepsy surgery is a well-established treatment for drug-resistant epilepsy, with awake craniotomy being used in certain cases to remove epileptogenic foci while preserving crucial brain functions. We are presenting the first reported case from Pakistan of a 19-year-old woman who underwent awake epilepsy surgery to treat cortical dysplasia. She had a history of generalized tonic-clonic seizures since her childhood and was referred to our clinic due to an increase in seizure frequency. EEG and MRI identified the epileptogenic focus in the right parieto-temporal region. The patient underwent a neuro-navigation guided awake craniotomy and an excision of the epileptogenic focus in the right parieto-temporal region. The procedure was carried out using a scalp block and dexmedetomidine for conscious sedation, enabling the patient to remain awake throughout the surgery. Intraoperative mapping and electrocorticography were used for complex multidisciplinary care. Post-resection corticography showed no spikes along the resected margins. The patient was discharged without any complications and remained free of symptoms a year after the surgery. Awake epilepsy surgery is a viable option for removing epileptogenic foci while preserving vital cognitive functions. However, it is seldom used in low- and middle-income countries such as Pakistan. The successful outcome of this case underscores the need for greater awareness and availability of epilepsy surgery in resource-limited settings. Cost-effective measures, such as using small subdural strips for intraoperative localization, can be implemented.
