• Mohammad Mofatteh, Mohammad Sadegh Mashayekhi, Saman Arfaie, Amos Olufemi Adeleye, Edward Olaoluwa Jolayemi, Nathalie C Ghomsi, Nathan A Shlobin, Ahmed A Morsy, Ignatius N Esene, Tsegazeab Laeke, Ahmed K Awad, Jason J Labuschagne, Richard Ruan, Yared Nigusie Abebe, John Nute Jabang, Abiodun Idowu Okunlola, Umaru Barrie, Hervé Monka Lekuya, Idi MarcelEhangaEDepartment of Neurosurgery, College of Surgeons of East, Central and Southern Africa/Mulago Hospital, Kampala, Uganda., Kantenga Dieu Merci Kabulo, BankoleNourou Dine AdeniranNDADepartment of Neurosurgery, Hôpital Des Spécialités, WFNS Rabat Training Center For Young, African Neurosurgeons, Faculty of Medicine, Mohammed V University, Rabat, Morocco., Idara J Edem, Chibuikem A Ikwuegbuenyi, Stephane Nguembu, Yvan Zolo, and Mark Bernstein.
• School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
• Neurosurgery. 2023 Aug 1; 93 (2): 274291274-291.

BackgroundAwake 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.ObjectiveTo review the published literature on AC in African countries, identify challenges, and propose pragmatic solutions by practicing neurosurgeons in Africa.MethodsWe 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.ResultsNineteen 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.ConclusionDespite 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.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Congress of Neurological Surgeons.

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