The idea to operate on brain tumors under local anesthesia came from knowing that the brain is a nonsensitive structure in spite of controlling the whole process of pain sensation. Surgery of brain tumors near eloquent areas may carry risk of neurological deficit or at least may limit the amount of tumor resection with bad prognostic effect in both situations. Operating on tumors near eloquent brain areas under scalp block and continuous neurological examination during tumor resection proved to be effective in early detection and prevention of permanent major deficits especially in the developing countries with limited resources. Two patients suffered from intraoperative seizures and conversion to general anesthesia was required in one patient. Gross or near total resection was achieved in 15cases, four cases had subtotal resection and biopsy only was done in 1 case. Tumors were related to motor cortex in 11 patients and to language areas in 9 patients. Forty percent of patients were presented by motor weakness. There were 12 males and 8 females with mean age 36.8 years. This work aims to evaluate safety, feasibility, and outcome of operating on patients with space occupying lesions near eloquent areas under scalp block being continuously examined by a neurologist through retrospective study of 20 cases with supratentorial lesions related to language or sensorimotor cortex. However, it requires certain anesthetic drugs, advanced techniques, and trained teams that are not available in every neurosurgical institute. Awake surgery is the gold standard procedure for such lesions. Surgery of the brain tumors near eloquent areas carries the risk of either disabling neurological deficit or inadequate resection with bad prognosis in both situations.
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