Transient Facial Nerve Palsy After Auriculotemporal Nerve Block in Awake Craniotomy Patients

Awake craniotomy is the preferred approach for neurosurgical procedures that require intraopera tive monitoring of eloquent areas.1,2 The successful anesthetic is based on patient cooperation, gentle surgi cal maneuvers and the anesthesiologist’s careful manage ment of sedation, hemodynamics, ventilatory variables and interaction with the patient.1 Local anesthetics are often used to anesthetize the surgical field by individually blocking the nerves that provide sensation to the scalp: the supratrochlear, supraorbital, zygomaticotemporal, auricu lotemporal, greater and lesser occipital nerves.3 When scalp nerve blocks are used, the total doses of local anesthetics and sedatives are decreased, and patient comfort is main tained.4,5 As a result, this technique reduces some of the most commonly described complications during anesthe sia for awake craniotomies, including pain, intraoperative arterial hypertension, hypoventilation, hypoxemia, nausea, and vomiting.3,5