Early institutional experiences of awake craniotomy with tumor removal at Chulabhorn Hospital, Thailand

Abstract

Background & Objective: Brain tumors in eloquent regions pose major surgical challenges due to the high risk of neurological deficits with conventional resection. Awake craniotomy mitigates these risks through intraoperative neurophysiological monitoring that helps preserve eloquent function. Yet its adoption and documentation in Thailand, and Southeast Asia more broadly, remain limited. This study aims to address this gap and support regional advancement and benchmarking of the technique.

Methods: We implemented a structured awake craniotomy program at Chulabhorn Hospital using a standardized asleep–awake–asleep (AAA) protocol with rigid skull fixation, informed in part by training from The Royal Melbourne Hospital.

Results: Eight patients with intracranial tumors in eloquent cortical areas underwent surgery under this protocol. One intraoperative and one postoperative seizure occurred. Motor function was preserved or improved in nearly all cases, with only a single instance of postoperative weakness. Language outcomes were stable in five patients and improved in three. Gross total resection was achieved in five procedures, while three achieved subtotal resections. There was no perioperative mortality, surgical site infection, or need for reoperation.

Conclusions: These findings on one of the few documented series of awake craniotomy in Thailand demonstrate that this technique can be safely introduced and effectively performed within emerging neurosurgical centers in Southeast Asia. Our experience shows that a standardized AAA protocol is both safe and feasible for tumor resection in eloquent brain regions and provides an important foundational step toward expanding the technique and strengthening regional neurosurgical capacity.