Improvements in brain tumor surgery: the modern history of awake craniotomies

Early archaeological records indicate that awake craniotomies in the form of trephination were successfully practiced long before the advent of general anesthesia.Skulls unearthed in Peru show complete healing in 55% of 214 patients.The possibility has been advanced that coca leaves may have allowed for trephination after cocaine-induced local anesthesia.In many ways, the modern era of awake craniotomies began more than 50 years ago when Wilder Penfield and André Pasquet published their landmark paper on the surgical and anesthetic aspects of surgery after administration of local and intermittent sedation and analgesia. 19Many of the concepts they outlined remain relevant today.The ability to perform awake craniotomies has become a part of the armamentarium of many neurosurgeons, with significant applications in neuro-oncology.An experienced surgical and anesthetic team is essential to performing these craniotomies.The fundamental concepts of cerebral localization and improved anesthetic techniques remain relevant.