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Seizure during awake craniotomy — FRCA Final MCQ

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ModerateNeurosurgical AnaesthesiaSeizure during awake craniotomyFRCA Final

A 51-year-old woman has an awake craniotomy for tumour near the motor cortex. During cortical stimulation she develops focal motor seizure activity in the contralateral arm, remains conscious, and oxygen saturation is 97%. What is the most appropriate management?

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Correct answer: E — Stop stimulation and irrigate the cortex with cold saline

Focal seizure during awake cortical mapping is commonly managed initially by stopping stimulation and applying cold saline to the cortex. General anaesthesia or anticonvulsants may be needed if seizure persists or generalises. Suxamethonium treats movement but not cortical seizure activity and would compromise awake testing. Calm communication and airway readiness are essential.

Reference: NACCS awake craniotomy guidance; RCoA Final FRCA Syllabus 2026