Awake craniotomy in a depressed and agitated patient

Depressed patients with brain tumors are often not referred to awake craniotomy because of concern of uncooperation which may increase the risk of perioperative complications. This report describes an interesting case of awake craniotomy for frontal lobe glioma in a 41-year-old woman undergoing language and motor mapping intraoperatively. As she was fearful and apprehensive and was on antidepressant therapy to control depression, the author adopted general anesthesia with laryngeal mask airway during initial stage of skull pinning and craniotomy procedures. Then, the patient reverted to awake state to continue the intended neurosurgical procedure. The patient tolerated the situation satisfactorily and was cooperative till the finish, without any event.