‘Awake brain surgery’ or ‘awake craniotomy’ is a groundbreaking brain surgery performed by some neurosurgeons (brain surgeons) while a person is awake. This type of surgery can be very effective at treating certain brain conditions. However, it is not suited to every condition or person.
What is awake brain surgery?
Awake brain surgery is a neurosurgical procedure that involves a neurosurgeon performing surgery on your brain while you are conscious (awake). This means you can interact, speak, move and respond to the surgeon while they are performing the procedure.
This surgical method can help remove or reduce the severity of some brain conditions, including some tumours and epileptic foci (parts of the brain causing epileptic seizures).
A neurosurgeon may do all or part of the operation while you are awake.
When is awake brain surgery recommended?
Awake brain surgery may be recommended if the brain area needing surgery is close to the parts that control speech, movement and sensation. This approach allows surgeons to pinpoint these critical areas accurately, minimising the risk of damage during the procedure.
However, not everyone is suited to awake brain surgery even if it could effectively treat their condition. Some people may not like the idea of being awake during surgery so they won’t be recommended this procedure. The surgeon will carefully select suitable patients and thoroughly inform them on what to expect.
What are the benefits?
Removing a tumour with awake brain surgery may improve your quality of life or extend your life. However, you may also need other treatment, including chemotherapy, immunotherapy or radiotherapy, to completely remove the tumour.
Removing an epileptic focus this way can reduce the number of seizures you experience or stop them altogether. However, sometimes the frequency of seizures won’t reduce despite a successful surgery.
What are the risks?
The risks of this surgical approach may include the following:
- vision changes
- speech problems
- memory or learning problems
- coordination or balance problems
- weak muscles
- leaking spinal fluid
- brain swelling
How is awake brain surgery performed?
Before the surgery begins, your neurosurgeon will assess your brain and condition using scans and 3D computer images. This is known as brain mapping and it helps the surgeon to see your brain before surgery so they can plan their approach.
The procedure itself actually begins with you asleep. The anaesthetist gives you medication to put you to sleep while the neurosurgeon secures your head so that it can’t move during surgery. They may shave off some of your hair so they can remove your skull and access your brain.
The anaesthetist will then control your medication to wake you up so the neurosurgeon can reach your brain. During the operation, your neurosurgeon may ask you questions, or ask you to identify pictures, count numbers, or move your limbs or fingers. Your responses help your surgeon to identify the exact parts of your brain that control your speech, movement and sensations to protect them.
Your neurosurgeon may request more 3D images of your brain during surgery and use a device that shows your brain activity. Monitoring both your responses and technology helps the surgeon to remove your condition as much and as accurately as possible.
How do I recover?
After your surgery, your surgeon may order scans to make sure the tumour or epileptic focus has gone.
You may need to stay in the intensive care unit (ICU) for a time after surgery and in a hospital ward for a few days.
Generally, people can get back to work and their regular activities within six weeks to three months after surgery.
Your surgeon will schedule a follow-up appointment with you three months after your surgery to check on your health and progress.
For comprehensive details or consultation, always consult with Dr Reddy.
Cancer Council, Understanding brain tumours
Mayo Clinic, Awake brain surgery
StatPearls Publishing, Anesthesia for awake craniotomy
Images by Injury Map under a Creative Commons license.