To prepare for surgeries that target brain tumors or epilepsy, or for placement of devices such as deep brain stimulation (DBS) implants, “awake” craniotomy is performed to determine which areas in the patient’s brain are responsible for certain functions.
Reasons for Awake Craniotomy
Awake Craniotomy enables the neurosurgeons to remove tumors that would otherwise be inoperable because:
• They are too close to areas of the brain that control vision, language and body movements.
• Surgery would result in a significant loss of function.
Awake Craniotomy Procedure
In this procedure, surgeons electrically stimulate regions of the brain while the patient is awake, to create a map of areas that should be avoided during surgery, such as areas that govern speech and movement.
Because the brain itself does not sense pain directly, an awake craniotomy can be performed while the patient is under local anesthesia. Awake craniotomy is major brain surgery that requires temporary removal of a portion of the skull to allow the surgeon access to the outer portion of the brain, or cerebral cortex. Because he or she is conscious during the procedure, the patient can report sensations in response to stimulation of specific brain areas. Sensations can be as specific as seeing an image (in response to stimulation of the visual cortex), to a feeling of déjà vu, to the movement of an arm or leg. These verbal reports and physical clues allow the surgeon to carefully plot a three-dimensional map of the brain and to pinpoint areas of disease or injury. Subsequent surgery can then minimize any damage to the brain that might compromise normal function. The anesthesiologist places the patient back under deep anesthesia after tumor resection to allow the neurosurgeon to complete the operation safely with no discomfort to the patient.
Awake craniotomies are performed in the intraoperative MRI suite that allows neurosurgeons to make real-time MRI images during the procedure. This lets surgeons get a high-resolution picture of the brain as another way to ensure that the maximum amount of tumor is safely removed.
If you had awake brain surgery to remove a tumor, you may still need other treatments, such as radiation therapy or chemotherapy, to help destroy remaining parts of the tumor.
Post-operative recovery is generally much quicker as you will not have had a general anaesthetic. You can eat, drink and move as soon as you feel able to and will be able to be discharged on the same day as your operation or the following day if you are able.
After any major operation, it takes a few weeks to recover fully. For the first couple of weeks you may have some headaches that you should be able to control with simple painkillers that you will be given. You will feel more tired than usual and will need to rest when you feel tired. However, you should do a simpler exercise each day such as taking walks.