The oldest finding is with Hippocrates whom performed this procedure in 377-460 A.C [4]. Craniotomy were first implemented to control convulsive crisis by Otfrid Foester and Wilver Penfield whom performed the first surgical intervention at the General Hospital of Massachusetts with the idea of having a cerebral outline, serving for neurological evaluation in precise areas of the brain like motor and sensitive language areas during the procedure to avoid neurological deficiencies posterior to the procedure. Mexico in 2012 performed their first attempt at the hospital Centro Medico Adolfo Lopez Mateos and in 2018 having first realized the asleep-awake-asleep craniotomy [9]. It is of utmost importance to previously evaluate the patient before performing the surgical procedure, must meet certain requirements and characteristics, “the patient must cooperate with the procedure, the patient is required to not present anxiety, somnolence disorientation or aphasia previous to procedure, airway must not be difficult to handle, present chronic pulmonary obstructive disease or obesity” [5]. Tumors are highly vascularized and must be handled with general anesthesia, which makes patient inadequate for this particular surgical procedure. Patient must be at least 10 years of age to be considered a candidate. Patients whom may be intervened are for meningioma, aneurisms, vascular and arteriorvenous malformations or with an affected area considered eloquent.

Patient gave informed signed consent. Masculine, 57 years old, began in 2013 with epileptic crisis’ while at work, which he is then taken to the Regional Military Hospital of Specialties in Guadalajara, having been attended by Neurosurgery an MRI is done immediately demonstrating a cerebral tumor. The patient is given options one being a surgical resection of the tumor and the gold standard treatment. The patient denies the surgical treatment and opts for his conventional treatment of Carbamazepine to control the convulsive crisis. Posterior to the consultation in 2017 he experiences left superior hemiparesis with thermal sensibility accompanied by pain, left dissymmetric alteration of coordination with ataxia in thorax and march altered with lateralization to the left deciding to follow up in October 2018 to be reevaluated by neurosurgery accepting the surgical procedure. Proceeding to blood analyses blood biometry concentrations: anemia with hemoglobin 10.60 g/dL, Hematocrit 33%, Total Leucocytes 17.3x10³/uL (94.2% neutrophils). Blood chemistry: Glucose 142 mg/dl, BUN 8.0 mg/dL, and Creatine 0.82 mg/dL.  The magnetic resonance imagery (MRI) identifies a heterogeneous mass of 2.9 x 1.8 cm observed in the right cerebral hemisfere characterized by a central region. In T1 imagery the distortion is found to be isointense as for in T2 hypointense. Perilesion edema in the frontal, parietal and temporal lobules.

The surgical procedure is continued applying the sleep-awake-asleep craniotomy technique having resected the tumor in 3.5 hours having the patient posteriorly experience a laryngeal spasm in the process of transoperation which complicated the hemodynamic stability, tachycardia and hypertension, with oxygen saturation decrease bringing together cerebral edema. It’s decided to continue procedure under general anesthesia due to complications previously mentioned then transferring patient to ICU where he presents an increase in convulsive crisis and decrease in the left hemiparesis prolonging his intrahospital stay for 3 days in ICU then transferring to the general hall where he spent another 4 days. It is essential and required to perform this surgical procedure in order to optimize the results and avoid probable complications that may be presented in the future.