Local anesthesia craniotomy for excision of a lesion at the critical functional area

Intraoperative cortical evoked-potentials functional mapping plays an important role in excision of a peri-Rolandic lesion. Yet, when patient's alertness and cooperation are required, craniotomy under local anesthesia becomes essential. In a series of nine patients, craniotomies were done under local anesthesia with a mean dose of 99 c.c. local anesthetic mixture and also some intravenous supplementary neuroleptic drugs if needed. The intraoperative vital sign monitoring did not present a problem. Continuous O₂ saturation monitoring showed adequate range with a mean of 98.5%. The postoperative stay in the Operating Room was only 7 minutes (mean) which was significantly shorter than when craniotomy had been done under general anesthesia. There was no major intraoperative problem, no postoperative complication. The results have shown that a craniotomy can be done safely under local anesthesia in selected situations.