Overview

Awake brain surgery, also known as awake craniotomy, is a procedure that is the complete opposite and defies all the rules of traditional surgery, as the patients remain conscious during the surgery. It is a revolutionary and innovative technique in neurosurgery, offering new possibilities and hope for patients with complex neurological conditions. In this blog, we will dive deep to understand the fascinating world of awake brain surgery.

Basics of awake brain surgery

Awake craniotomy is a specialised surgical procedure that involves temporarily removing the skull of a patient to access the brain. The patient is sedated at the time of the initial step, but they are typically awake and alert for some or all of the surgery. The purpose of performing awake brain surgery is to allow surgeons to minimise the risk of damaging essential brain tissue while removing tumours or treating people with epilepsy. This unique approach allows the surgeons to have a real-time interaction with the patient that gives them feedback about stimulating any functional tissue of the brain. If so, then the surgeons avoid resection of this function brain tissue. This process of stimulating various parts of the brain to assess function and identify critical areas responsible for speech, movement, and sensation is known as cortical mapping.

It can be frightening or disconcerting for people to undergo awake craniotomy. Hence, the surgical team ensures that the patients are counselled and prepared for the surgery. Even during the surgery, the surgical team takes adequate measures to make the patient comfortable.

Awake brain surgery is mainly opted for patients with brain tumours or epilepsy, especially in cases where the lesions are near critical brain areas. Besides removing the tumours, the surgery is used for other neurological procedures, including deep brain stimulation for conditions such as Parkinson's disease, brain biopsy (tissue analysis), ventriculostomy to drain excess brain fluid, and interventional pain procedures to address acute or chronic pain conditions.

How Awake Brain Surgery Works

Before Surgery: Even before beginning the process or even sedating the patient, the doctors first determine if awake brain surgery is the right choice for you. Next, the surgeon prepares the patient for the surgery by explaining what to expect during the procedure and the benefits and risks of awake brain surgery. A neurosurgeon or a speech-language pathologist may ask you to identify some pictures and words on a set of cards or displayed on a computer. Finally, the patient receives local anaesthesia to numb the scalp and skull, ensuring they remain pain-free throughout the procedure. The surgical team collects the patient's responses for comparison with those during surgery.
During Surgery: Once the patient is sedated, the surgeon opens the skull to access the brain. The patient's head is placed in a fixed position to keep the head still during the procedure. If the tumour or epileptic focus is close to areas of the brain controlling vision, speech or movement, then the surgeons will conduct a brain mapping. It is the process of creating a brain map to help neurosurgeons navigate through the brain centres responsible for speech, movement, and sensation. It is possible for surgeons with the help of imaging techniques and sometimes electrical stimulation. At this point, your anesthesiologist will stop administering the sedative medications and allow you to wake up. While the patient is conscious, the surgeon or the speech-language pathologist will ask questions about the pictures and words on the cards or computer that the patient saw before the surgery. A comparison of responses from before and during the surgery will help your surgeon avoid the functional areas in your brain.
After Surgery: Post-surgery, the surgeons ensure that the tumour or the epileptic focus is removed by requesting an MRI scan to confirm. After surgery, patients are transferred to the intensive care unit. Following this, they may stay in the hospital for two to three days. Patients gradually return to normal activities, including work, over the next six weeks to three months. With proper care, rehabilitation, and regular follow-up appointments, patients can experience improved outcomes and quality of life.

Advantages and Challenges

The advantages of awake brain surgery include enhanced precision, reduced risk of complications, and improved functional outcomes. The recovery time is quicker, and the quality of life post-surgery is better.

With so many advantages, there are certain limitations or challenges that awake brain surgery presents. These include anxiety and discomfort, technical complexities, and risk of damage to critical brain functions. Additionally, the procedure carries inherent risks such as bleeding, infection, and neurological deficits, necessitating vigilant monitoring and specialised expertise from the surgical team.

Conclusion

Awake brain surgery is a remarkable advancement in medical care. By using real-time brain mapping and engaging with patients during surgery, surgeons can navigate the complexities of the brain with incredible accuracy and compassion. This procedure underscores medical professionals' commitment to improving patient outcomes and advancing our understanding of the brain. Although this blog provides only an overview, awake brain surgery remains an intriguing field that inspires hope and promises a better future for neurosurgery.

FAQs for awake brain surgery

Q1. What can I expect during awake brain surgery?
A1. During awake brain surgery, you can expect to be awake and alert while the surgical team maps your brain and may ask you to perform tasks to help identify critical areas.

Q2. What are the risks of awake brain surgery?
A2. The risks of awake brain surgery include bleeding, infection, and neurological deficits, although these are minimised with careful patient selection and monitoring.

Q3. What conditions can be treated with awake brain surgery?
A3. Awake brain surgery is used to remove brain tumours, treat epilepsy, perform deep brain stimulation for conditions like Parkinson's disease, and conduct brain biopsies or ventriculostomy procedures.

Q4. Can anyone undergo awake brain surgery?
A4. Not all patients are suitable candidates for awake brain surgery. Factors such as the location and size of the tumour, overall health, and ability to tolerate the procedure are considered when determining eligibility.

References:

https://www.mayoclinic.org/tests-procedures/awake-brain-surgery/about/pac-20384913#:~:text=Awake%20brain%20surgery%2C%20also%20called,brain%20tumors%20or%20epileptic%20seizures.
https://www.ncbi.nlm.nih.gov/books/NBK572053/
https://www.medicalnewstoday.com/articles/awake-brain-surgery#uses
https://braintumorcenter.ucsf.edu/treatments/surgery/awake-brain-mapping-faq