Awake Craniotomy, Functional Neurosurgery, and Neuro-Interventional Radiology — WACS Viva & Clinical Scenarios (Neuroanaesthesia)

Exam-style awake craniotomy, functional neurosurgery, and neuro-interventional radiology viva scenarios with examiner probes and model answers for ANAESTHESIA…

Scenarios covered

• SCENARIO 1: Scenario 1: A 36-year-old schoolteacher presents with focal motor seizures. Brain MRI shows a 4 cm low-grade glioma in the left inferior frontal gyrus adjacent to Broca's area. She is scheduled for an awake craniotomy with intraoperative speech testing. Detail your pre-anaesthetic psychological preparation, your choice of anaesthetic technique (Asleep-Awake-Asleep vs Monitored Anaesthesia Care), your scalp block technique, and drug infusion protocols.
• SCENARIO 2: Scenario 2: During cortical stimulation mapping for an awake craniotomy in a 29-year-old male, the patient develops a sudden intraoperative focal motor seizure that rapidly generalizes into a tonic-clonic convulsion. His head is secured in the Mayfield three-pin clamp, and the surgical drapes are open. Detail your immediate, step-by-step crisis management.
• SCENARIO 3: Scenario 3: An 80-year-old man is transferred to the catheterization laboratory for emergency endovascular mechanical thrombectomy 4.5 hours after sudden right hemiplegia and aphasia (NIHSS 18). Describe the pros and cons of general anaesthesia with endotracheal intubation versus conscious sedation in this patient and outline your haemodynamic blood pressure targets.
• SCENARIO 4: Scenario 4: During endovascular coiling of a wide-necked anterior communicating aneurysm under general anaesthesia in the radiology suite, the interventional neuroradiologist announces that the aneurysm has ruptured during microcoil deployment. Contrast media is seen extravasating into the subarachnoid space. Formulate your immediate anaesthetic actions.