Awake brain surgery, also known as awake craniotomy, is a specialized neurosurgical procedure where the patient remains conscious for a portion of the operation. This technique is employed to treat certain neurological conditions, such as specific brain tumors or epileptic seizures.
Protecting Vital Brain Functions
The primary reason for keeping a patient awake during brain surgery is to protect “eloquent areas” of the brain. These regions are responsible for functions like speech, language comprehension, motor skills, and sensation. It can be difficult to precisely locate these areas before surgery.
Being awake allows the surgical team to perform real-time brain mapping, also known as cortical mapping. Surgeons use a low electrical current to stimulate different parts of the brain while the patient performs specific tasks. If stimulation temporarily affects a function, like speech or movement, the surgeon knows to avoid that area during tumor removal. This direct feedback helps minimize the risk of irreversible neurological damage, allowing for safer and more complete removal of the affected tissue.
The Awake Craniotomy Procedure
During an awake craniotomy, patients are conscious but experience no pain from the brain itself, as brain tissue lacks pain receptors. The scalp and skull are thoroughly numbed using local anesthesia. Patients may feel pressure or vibrations, but not sharp pain.
The procedure often involves an “awake-sleep-awake” approach. The patient is sedated for the initial stages, such as the scalp incision and the removal of a piece of the skull (craniotomy). Once the brain is exposed, sedation is reduced, and the patient is gently awakened to participate in the mapping process.
Throughout the awake phase, the surgical team communicates continuously with the patient. They may ask the patient to speak, move limbs, identify objects, or read words from a screen. This real-time interaction guides the surgeon in identifying and preserving functional brain areas. The patient is sedated again for the final stages of closing the skull.
Conditions Requiring Awake Surgery
Awake brain surgery is not a universal solution for all brain conditions; rather, it is indicated for situations where the lesion is in close proximity to functional brain regions. This technique is used for removing brain tumors that are located in or near areas controlling speech, movement, or sensation.
It is also employed for epilepsy surgeries when the seizure-causing area is situated near these eloquent brain centers. The decision to perform an awake craniotomy is based on the tumor’s location and its relationship to these neurological functions, aiming to maximize tumor removal while safeguarding the patient’s abilities.
Ensuring Patient Comfort and Safety
Ensuring the patient’s comfort and safety is important during an awake craniotomy. A multidisciplinary team, including neurosurgeons, anesthesiologists, neurologists, and nurses, works together to manage the patient’s experience. This team continuously monitors vital signs and brain activity throughout the procedure.
Pain and anxiety are managed through controlled sedation and the application of local anesthesia to the scalp and skull. Patients report satisfaction, feeling a sense of control by actively participating in the surgery. Preoperative preparation and open communication with the medical team are important in alleviating patient anxiety.