Background:
Epilepsy surgery is a treatment option for temporal lobe epilepsy because this type of epilepsy often does not respond to anti-seizure medications and ultimately becomes intractable epilepsy. However, there is a risk of decreased cognitive function post-operatively, especially in surgery on the dominant hemisphere. This risk can be minimized with cognitive mapping and direct electrical stimulation (DES) during awake craniotomy. This allows for more precise resection and protects critical brain areas. The selection of tests for intraoperative cognitive mapping requires special attention, given the limited examination time.

Case Presentation:

This is a case of a 23-year-old woman who had suffered from epilepsy for 9 years. Head magnetic resonance imaging (MRI) and electroencephalography (EEG) results were consistent with temporal lobe epilepsy originating in the left hemisphere. The patient continued to have seizures despite regularly taking ≥2 antiseizure medications. The patient subsequently underwent a left temporal lobectomy and left hippocampectomy using a sleep-awake-asleep craniotomy technique and intraoperative language testing. Postoperatively, the patient showed mild impairment in visual and verbal delayed memory function, but no language impairment was found.

Conclusion:
To date, awake craniotomy has been performed at several referral hospitals in Indonesia, both for epilepsy and tumors. However, awake craniotomy with cognitive mapping has not been widely reported. This case report is expected to serve as a model for similar cases, as it has been shown to be beneficial in preventing post-operative cognitive complications.

Keywords: awake craniotomy; intraoperative cognitive assessment; temporal lobectomy