Awake Craniotomy: Understanding the Surgical Procedure
- An awake craniotomy is a specialized surgical procedure to remove glioma. It is performed while the patient is awake but comfortable.
- This technique is used when the tumor is located near areas of the brain responsible for functions such as speech, movement, or vision.
- The procedure begins with the administration of anesthesia to keep the patient relaxed and pain-free. The surgical team will carefully expose the brain while the patient is still under sedation.
- Once the critical portion of the surgery begins, the patient is awakened and asked to participate in neurological assessments, like speaking or moving arms and legs.
- During the procedure, some discomfort or pressure may be experienced, but the surgical team will closely monitor the patient’s comfort levels.
An awake craniotomy is a specialized surgical procedure performed while the patient is awake but comfortable. This technique is used when the tumor is located near areas of the brain responsible for functions such as speech, movement, or vision.
Read MoreThe Principle of Maximal Safe Resection
Neurosurgeons follow a principle known as maximal safe resection, meaning they aim to remove the largest possible portion of the tumor while minimizing harm to essential brain functions. The extent of resection depends on whether the tumor is located in or near an “eloquent” area of the brain.
Eloquent brain areas are responsible for critical functions such as speech, movement, and sensation. If a tumor is located in one of these areas, special precautions are taken to protect these functions. This often involves advanced brain mapping techniques and, in some cases, an awake craniotomy to ensure that surgical removal does not impair essential neurological abilities.
Understanding Awake Craniotomy
During an awake craniotomy, patients are awake, but made comfortable. By keeping the patient awake during key portions of the surgery, neurosurgeons can continuously monitor brain function, ensuring that critical areas are not damaged while the tumor is removed.
The procedure begins with the administration of anesthesia to keep the patient relaxed and pain-free. The surgical team will carefully expose the brain while the patient is still under sedation.
Once the critical portion of the surgery begins, the patient is gently awakened to actively participate in neurological assessments.
“We guide them through certain functional activities that we have them do sitting on the operating room table while we stimulate their brain with electricity to map out the cortical and subcortical anatomy and function so we know where it’s safe to remove tumor and where it’s not,” Dr. Ormond explains.
During this phase, the surgeon and medical team guide the patient through specific functional tasks, such as:
- Speaking or naming objects
- Moving their arms or legs
- Describing sensations
By stimulating different areas of the brain with mild electrical impulses, the surgical team can precisely identify which areas are responsible for crucial functions. This mapping process ensures that the tumor is removed as safely as possible, minimizing the risk of postoperative deficits.
Will I Feel Pain If I Am Awake?
Understandably, one of the biggest concerns for patients undergoing an awake craniotomy is whether they will experience pain. The good news is that the brain itself does not have pain receptors, meaning that once the scalp and skull are numbed with anesthesia, the patient should not feel pain from the procedure itself.
Some discomfort or pressure may be experienced, but the surgical team closely monitors the patient’s comfort throughout the operation.
Additionally, anesthesia and sedation techniques are used strategically so that the patient is awake only for the crucial mapping phase. Before and after this part of the surgery, patients remain in a deeply relaxed or sedated state.
How Long Does the Procedure Take?
The duration of an awake craniotomy varies depending on factors such as the tumor’s size and location.
On average, the surgery takes between four to six hours from start to finish. The actual time the patient is awake is usually limited to a shorter portion of the procedure — just long enough to map brain function accurately.
Recovery After an Awake Craniotomy
Following the procedure, patients are carefully monitored in a recovery unit.
Some individuals may experience temporary speech difficulties, mild weakness, or fatigue, but these symptoms often improve over time. The length of hospital stay varies, but most patients remain in the hospital for a few days to ensure proper healing and neurological recovery.
Recovery from an awake craniotomy varies for each individual. Some patients can resume normal activities within a few weeks, while others may require rehabilitation, such as physical or speech therapy, depending on the effects of surgery.
Your healthcare team will work closely with you to create a personalized recovery plan.
The treatment of gliomas involves a multidisciplinary team, including neurosurgeons, neurologists, oncologists, and rehabilitation specialists. In some cases, surgery is followed by additional therapies such as radiation and chemotherapy to target any remaining cancer cells.
Questions to Ask Your Doctor
- Am I a good candidate for surgery?
- Do you recommend an awake craniotomy?
- What are the risks vs. benefits of this procedure?
- How will I be monitored during the procedure?
- How will I be monitored after surgery?
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