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KMID : 1035520230110040289
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Brain Tumor Research and Treatment : BTRT
2023 Volume.11 No. 4 p.289 ~ p.294
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Awake Surgery for Lesional Epilepsy in Resource-Limited Settings: Case Report and Review of Literature
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Mohammad Hamza Bajwa
Syeda Amrah Hashmi
Abdullah Nisar
Muhammad Waqas Baqai
Saqib Kamran Bakhshi
Muskaan Abdul Qadir
Faraz Shafiq
Syed Ather Enam
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Abstract
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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.
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KEYWORD
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Drug resistant epilepsy, Neurosurgery, Anesthesia, Resource-limited settings
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