Awake Brain Surgery, also known as ‘Awake Craniotomy’, is defined as an intracranial surgical procedure in which the surgeon deliberately awakens the patient for a portion of the surgery to interact and observe, while mapping resection of the lesion. It’s a highly specialized surgical procedure requiring expert neurosurgeons and a neuro-anesthesiologist.
Awake craniotomy is performed on patients suffering from certain types of brain tumours or lesions that result in frequent episodes of epileptic seizures. The tumours are mostly found close to the part of the brain associated with vision, speech, and movement (eloquent regions of the brain). Some tumours spread throughout the brain without showing clear borders such as Glioma. This requires the removal or shrinking of tumours through an awake craniotomy. However, the only critical risk related to the surgery is a significant loss to any body movement.
Some other risk of ‘awake’ brain surgery can be:
• Seizures
• Stroke
• Meningitis
• Swelling or too much fluid in the brain
• Loss of memory
• Difficulty in speech
• Vision problems
• Weak Muscles
• Impaired balance or coordination
Tumours causing seizures need surgical removal but sometimes pinpointing the exact areas before surgery becomes challenging due to multiple reasons. In ‘awake’ brain surgery, the surgeon learns which areas of the brain control the eloquent regions and motor skills to avoid damaging specific parts and functions during the procedure, explain Neurologists of AMRI Hospitals
Is it painful?
Luckily, our brain tissues don’t have any pain fibres, so there are chances one may feel certain sensations, vibrations or pressure from the surgery, but not pain. The neuro-anesthesiologist will inject anaesthesia to numb the muscles, bone, and skin of the regions that have to be cut through to get to the part of the brain where the tumour resides.
Surgical Procedure
Depending upon the tumour’s location, size, and symptoms a patient had shown before surgery, the procedure could take anywhere between 60 minutes to several hours. The patient’s role is crucial during the awakened part of the surgery, as they have to help during the mapping of their own brain functions as per the neurosurgeon’s instructions. The neurosurgeon stimulates the brain region near the tumour by sending a light electric current down the nerves.
The neuro-anesthesiologist will ask to perform verbal or active tasks to check if the stimulation affected your neurological functions. For instance, you might be asked for any personal details, or be shown some objects for recall or be asked to perform any signal. If you are unable to talk or fumble, the neurosurgeon will get to know that the area connected to speech is stimulated.
Even when the patient is not directed to be active during mapping, they can still be connected to neurosurgeon and neuro-anesthesiologist with constant discussion, through which doctors will observe and lower the risks of damage to functional areas of the brain. However, once the incision is closed, the patient is put back to sleep after the possible neurological exam.
Pre-preparation before an ‘awake’ brain surgery
Your neurosurgeon will discuss all the outcomes of the surgery, and you can clarify all doubts, share your concerns and learn about the entire procedure. With advancements in surgical procedures, it has become easier for surgeons to interact with patients in various ways. The understanding between the patient and the surgeon is necessary for such complex surgeries and helps to get through with the mapping procedure more easily.