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Mofatteh, Mohammad; Mashayekhi, Mohammad Sadegh; Arfaie, Saman; Adeleye, Amos Olufemi; Jolayemi, Edward Olaoluwa; Ghomsi, Nathalie C; Shlobin, Nathan A; Morsy, Ahmed A; Esene, Ignatius N; Laeke, Tsegazeab; Awad, Ahmed K; Labuschagne, Jason J; Ruan, Richard; Abebe, Yared Nigusie; Jabang, John Nute; Okunlola, Abiodun Idowu; Barrie, Umaru; Lekuya, Hervé Monka; Idi Marcel, Ehanga; Kabulo, Kantenga Dieu Merci; Bankole, Nourou Dine Adeniran; Edem, Idara J; Ikwuegbuenyi, Chibuikem A; Nguembu, Stephane; Zolo, Yvan; Bernstein, Mark
Neurosurgery, 08/2023, Volume: 93, Issue: 2Journal Article
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. To review the published literature on AC in African countries, identify challenges, and propose pragmatic solutions by practicing neurosurgeons in Africa. 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. 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. 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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