Awake Brain Surgery/ Awake Craniotomy

This approach is particularly helpful for operations of critical areas of the brain that regulate motor, speech, and sensory functions because it avoids damage to these areas, hence ensuring a better surgical outcome.

Marengo Asia Hospitals specialises in the latest neurosurgery procedures, including awake brain surgery. Our highly skilled neurosurgeons leverage advanced technology and tailor treatment to achieve the best outcome for complex brain conditions. Striving for the comfort and the utmost safety of our patients, we carry out innovative techniques to minimise the risks involved and ensure less recovery time.

Who Needs Awake Brain Surgery?

Awake brain surgery/awake craniotomy is generally used on patients who have brain tumours, epilepsy, or other neurological disorders where it is necessary to retain functions such as speech, motor skills, or vision.

This procedure is done on patients whose abnormalities are related to the parts of the brain that are involved in essential functions. The surgical team keeps the patient awake during the procedure so they can monitor the responses of the patient and ensure that all the essential vital functions are not lost.

What Conditions Are Treated Using Awake Brain Surgery?

The main application of awake brain surgery is for those conditions that lie within or near vital areas of the brain, thereby helping with vital functions such as movement, speech, and cognition.

In this way, the medical team can observe and protect the essential functions during surgery. Examples of conditions that may require awake surgery include:

• Movement Disorders
• Brain Stem Lesions
• Cortical Dysplasia
• Dystonia
• Certain Psychiatric Problems
• Brain Tumours
• Epilepsy
• Arteriovenous Malformations (AVMs)
• Functional Brain Lesions
• Gliomas in Eloquent Brain Areas
• Brain Abscesses or Infections in Critical Regions

What Are the Benefits of Awake Brain Surgery?

Awake brain surgery offers numerous advantages over traditional brain surgery, mainly for patients with diseases related to critical parts of the brain. The surgeon can talk and interact with the patient during awake brain surgery, thus increasing the precision of the operation and reducing the likelihood of sensitive parts of the brain getting harmed. Some benefits of awake brain surgery are listed below:

1. Improved Precision and Safety: Since the surgical team can determine the exact critical parts of the brain that give control over functions concerning some activities of the motor type, speech, and cognition, those crucial functions were kept intact without them being touched during the surgery.

2. Real-Time Monitoring: At several points during the surgery, a command can be given to the patient to talk or move his hand. This way, the surgeon could ensure that those functions were intact during the surgery.

3. Reduced Recovery Time: The surgery is more defined and less invasive than the typical brain surgery; thus, leads to faster recovery than the usual brain surgeries.

4. Better Outcomes for Complex Conditions: Patients whose tumours are located in areas of the brain recognized as critical, such as in the speech centre or the motor cortex, will be benefited from access to real-time monitoring of how their brain will react to the treatment and thus improve the surgical outcome.

If you want to find an experienced surgeon for Awake Brain Surgery, you just need to visit our website. Once you are on our site, scroll a bit to discover the "Find a Doctor" section, where you’ll also find options to "Find a Hospital" and "Book an Appointment." Once this is done, click on "Find a Doctor," enter "Neurosurgery" as the specialty, and pick your desired location for treatment.

What Tests and Preparations are Needed Before Awake Brain Surgery?

Pre-surgical tests and preparations are usually performed before awake brain surgery to ensure a great outcome from the surgery. Such tests will help the surgical team to prepare for the procedure and avoid causing damage to brain areas that are critical. The major tests and preparations are as follows:

• MRI and CT Scans: These tests help in finding the location of the tumour or abnormal area of the brain in relation to surrounding brain structures. MRI is an imaging technique that provides clear and detailed images of the tissue, and a CT scan gives recognizable views of the bone structures. MRI and CT scans assist the healthcare provider in planning the surgery and avoiding crucial areas of the brain like the motor or speech centres.
• Neuropsychological Evaluation: A neuropsychological evaluation will assess aspects of cognitive functions, including memory, language, and motor abilities. This will assist the surgical team in understanding which parts of the brain are critical for the patient to perform daily activities. These can then be taken into account when preparing for surgery to avoid risks in these areas.
• Functional Mapping: The techniques of functional mapping involve activating specific parts of the brain to locate areas of the brain responsible for critical functions such as movement and speech. This way, the surgeon avoids destroying important brain tissue during his operation, which makes for a more precise and safer operation.

How to prepare for Awake Brain Surgery?

Preparing the patient well before undergoing awake brain surgery is necessary to ensure a smooth procedure and optimal recovery. Such preparation steps which the patient should undertake include:

1. Medicines: This is one area whereby a patient is expected to report all the prescription drugs, non-prescription drugs, vitamins, or supplements they have been taking. Some of these drugs may need to be adjusted or even completely stopped depending on the time and type of surgery. It is done to minimise the risks of developing complications during a surgical process. Your healthcare team will recommend which ones to take or withhold before your surgical procedure.

2. Fasting: Patients are generally instructed to refrain from taking food and/or liquids for a few hours prior to surgery. Fasting eliminates most of the risks associated with anaesthesia administration and ensures that the patient's stomach is empty at the time of the intervention. This is indispensable for safe anaesthesia administration.

3. Preparing Your Mind: Since awake brain surgery may seem scary, mental preparation forms a very significant part of this whole process. Any fear or concern could be addressed with the surgeon or anesthesiologist prior to the process. Detailed descriptions of the procedure and familiarisation of what to expect would allow the patient to feel less anxious and more relaxed during the surgery. Psychological support or counselling can also be provided to those who feel that they are too anxious.

4. Pre-Surgical Testing: Beyond the usual preoperative tests, like blood work and imaging, the full neuropsychological evaluation may be done by your surgeon to examine cognitive function, outlining key brain areas. These evaluations ensure that the neurosurgical team gets a comprehensive understanding of the patient's brain functions, which makes the surgery more precise and effective.

5. Preparing for Hospital Stay: Patients should prepare for a few days' hospital stay after the surgery. Keeping important items like toiletries, medical and insurance documents, and comfortable clothing options will help ensure an easy recovery period. The patient should also arrange for a house help or caregiver to provide help once he/she is discharged.

What Happens During an Awake Brain Surgery?

Awake craniotomy is a rather controlled procedure where sedation and monitoring allow the patient to be as comfortable as possible, yet do permit true-time interaction in the way to protect paramount brain functions. Here's a general outline of how the surgery is performed:

Sedation and Numbing

At the beginning of the procedure, an anesthesiologist will administer drugs to the patient so that they may go to sleep and relax. He/she will also apply local anaesthetics on the scalp to numb all the sensations, ensuring maximum comfort during the procedure. The patient will be drowsy when the skull is to be opened and closed but is likely to be conscious for the most important part of the surgery.

Head Positioning and Skull Removal

The patient's head is then fixed in place with considerable support to ensure stability during the procedure. In some cases, hair has to be cut to access the surgery site. The surgeon removes part of the skull to open access to the brain. The patient is kept sedated throughout this process of opening and closing of the skull.

Awakening and Brain Mapping

Once the skull is opened and the patient is stabilised, the anesthesiologist starts the process of weaning down the sedative medications to wake up the patient. In the meantime, the surgical team can use brain mapping techniques if the tumour or the area of concern is close to regions controlling vital functions such as speech, movement, or vision. The process, therefore, activates specific parts of the brain and then identifies what particular areas or parts of the brain carry out these functions, leading to a map that helps the surgeon operate.

Functional Testing and Interaction

During the operation, the patient may be requested to name various objects, count objects, or identify pictures on cards or screens. They may also be requested to move their hand or raise a finger. Such responses help the surgeon pinpoint and avoid brain areas that are critical for those functions. Interacting with the patient ensures the surgeon does not accidentally damage those areas responsible for speech, motor skills, and other cognitive functions.

Advanced Imaging and Guidance

Advanced imaging is used throughout the surgery by the surgical team to guide resection or tumour removal with 3D computer models and intraoperative MRI. These images provide a real-time view for the surgical team of brain structure and changes due to surgery. The surgical team uses this visual information to take out as much abnormal tissue as possible and minimise damage to healthy portions of the brain.

Monitoring and Safety

The whole process of surgery is closely monitored by the surgical team, including the anesthesiologist, who continuously monitors brain and body functions during the procedure. If changes in brain functions are seen, the team can immediately change the approach of the procedure, making it safer and more effective with minimal complications.

Post-Surgery Recovery and Considerations

Recovery after awake brain surgery is one of the most important stages, as it ensures proper healing of the patient and any new changes in the patient's anatomy due to the surgery. The length of recovery varies according to the complexity of the surgery, the area of the brain that was operated upon, and the general health of the patient. The main elements included in post-surgical care are as follows:

• Pain Management: Patients may experience pain on their scalp after the procedure. Pain management is part of the recovery, therefore, physicians will prescribe certain pain medications to help alleviate the soreness and discomfort. A close eye will be kept on your pain, so medications may have to be adjusted for optimal effects while keeping side effects to a minimum.
• Physical and Occupational Therapy: In some instances, especially if the injured parts are relative to movement or speech, rehabilitation is extremely important. For instance, it can be through physical therapy so that individuals can regain strength and coordination again. Similarly, occupational therapy will improve the skills for daily living. In the case of some brain functional deficits relevant to speech or fine motor skills, corresponding therapy would be indicated to help the patient regain lost functions. These therapies tend to be personalised depending on the area involved and might last for weeks even after surgery.
• Cognitive and Speech Rehabilitation: Patients may also be consulting speech therapists to recover the verbal communication if such parts of their brain which controlled speech or thought were affected. A neuropsychologist can help in cognitive rehabilitation to ensure changes in the memory, problem-solving, or other cognitive features of the patient. Mental clarity and functional communication are enhanced through continuous therapy and exercises on cognition.
• Follow-Up Appointments: After surgery, follow-up appointments with the neurosurgery team are important and effective in monitoring recovery and the success of the process. These visits may include checkup exams, imaging tests, or assessments for the healing of the patient. Potential complications such as infection, bleeding, or neurological changes would also be evaluated to make them manageable and address any issues in due time. Regular follow-ups will give the patient the opportunity to ask any questions concerning recovery.
• Monitoring for Complications: During the early postoperative period, the patient should be closely followed up for signs of complications such as infection, swelling, or any neurological changes. It is wise for the patients to always notify the surgery team if new signs or worsening symptoms occur, like headache, dizziness, or weakness. Early intervention lowers the chances of secondary complications.