Awake Brain Surgery: Is It As Scary As It Sounds?

By: Neda Brinster

Background

Typically, when an individual undergoes brain surgery, they are put to sleep through anesthesia. However, Awake brain surgery, or awake craniotomy, is a surgical method in which patients must stay awake and alert to treat neurological conditions such as brain tumors or epileptic seizures. 

How does it work?

During the operation, the surgeon will ask questions to monitor your responses and brain activity. As you answer each question, the surgeon will ensure they are treating the correct area of your brain. For example, patients who need to stay awake typically have seizures or tumors near regions of the brain that control movement, speech, vision, and other functions. If you struggle to answer questions or communicate that your vision is becoming obscured, the surgeon knows how to correct that promptly. (1)

Risks of Awake Brain Surgery

• Obscured vision

• Seizures

• Speech and learning difficulties

• Loss of memory

• Strokes

• Swelling of the brain

• Weak muscles

• Meningitis (Infection)

• Leaking cerebrospinal fluid

Typical Tumors Requiring Awake Brain Surgery:

If a tumor is located in an area that controls critical functions like language, sensation, and body movement, awake brain surgery is required. Tumors that are embedded within the brain, such as gliomas, ependymomas, and brain metastasis, are also recommended to be removed via awake craniotomy. (2) 

Surgical Procedures:

Although you must be awake while the surgeon is removing a tumor, you will initially be sedated while the surgeon removes part of your skull to gain access to the brain. Once that is done, the anesthesiologist slowly begins to drawback the sedative medications, waking you up. 

Once you are awake, Brain mapping and 3-D computer images are used by the surgeon to pinpoint the location of your tumor or epileptic focus without damaging other areas of the brain. As the surgeon begins removing or working on the identified area of the brain, they will ask you questions such as identifying pictures on cards, counting, and raising a finger. All of these questions allow the surgeon to ensure your brain function is maintained and operating on the correct area.

Surgical Operation in Pictures (3)

1. Patient Preparation (Under Anesthesia)

2. Skin Incision

3. Craniotomy (Removing the skull to access the brain)

4. Brain Exposure and Surgery

5. Awake Mapping (to access the correct area of the brain)

6. Closure

Citations:

“Awake Brain Surgery.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 7 May 2019, www.mayoclinic.org/tests-procedures/awake-brain-surgery/about/pac-20384913. (1)

“Awake Brain Mapping FAQ.” Awake Brain Mapping FAQ | UCSF Brain Tumor Center, braintumorcenter.ucsf.edu/treatments/surgery/awake-brain-mapping-faq. Accessed 11 Dec. 2023. (2)

Aaron Cohen-Gadol, M.D. “Awake Craniotomy: Expert Surgeon.” Awake Craniotomy | Expert Surgeon | Aaron Cohen-Gadol, MD, The Neurosurgical Atlas, 25 Sept. 2023, www.aaroncohen-gadol.com/en/patients/craniotomy/awake-craniotomy. (3)