Awake Brain Surgery

Awake brain surgery is a kind of surgery performed while you are awake to treat some neurological conditions, including brain tumors or epileptic seizures.

If your tumor or seizure center is close to the parts of your brain that control vision, movement or speech, you may be awake during surgery to respond to your surgeon.

Your responses aid your doctor in ensuring that he or she treats the specific part of your brain needing surgery.

In addition, the procedures lower the possibility of damage to functional areas of your brain.

Awake brain surgery has been specifically designed for removing tumors that would otherwise be inoperable because of the following reasons:

They are too close to the areas of the brain that control vision, language, and other body movements also because surgery would result in a significant loss of function.

Neurosurgeons perform awake brain surgery for tumors that have spread throughout the brain and do not have clear borders, such as some types of glioma. Awake brain surgery can shrink these tumors.

The potential risks of awake brain surgery may include:

• temporary or permanent neurological deficit like paralysis of limbs or loss of speech
• haematoma (blood) clot
• brain swelling
• infection
• fits
• Cerebrospinal fluid leakage
• general medical complications
• deep vein thrombosis (clot in the veins of the legs)
• pneumonia
• heart attack
• urinary tract infection

Some of these complications may be serious enough to warrant further surgery and some can be life threatening.

Here’s what you can expect before, during, and after your awake brain surgery.

The procedure is usually performed after a patient's scalp has been numbed and usually with the patient sedated.

The neurosurgeon works very closely with the neuro-anaesthesiologist. Together they will decide if awake brain surgery is right for a particular patient depending on the following:

• the importance of awake brain surgery in removing the tumor without damaging any vital parts of the brain
• the patient's general health and whether the patient will be able to remain calm during the procedure and respond to the neurosurgeon

If an awake brain surgery is recommended and the patient agrees, the neuro-anesthesiologist will explain the procedure in detail and answer any question the patient has.

The neurosurgeon and neuro-anesthesiologist will collaborate to determine the most appropriate type of anaesthesia for each patient.

The patient may be

Awake through the procedure (receive a nerve or scalp block), sedated at the beginning and end of the procedure and awake in the middle and the patient can be put to sleep at the beginning and end of the procedure and awake in the middle.

During surgery

The neurosurgeon will stimulate the area around the tumor with electrodes. In order to precisely locate the functional areas of the brain that must be avoided, the neurosurgeon will ask the patient to perform tasks like talking, counting and looking at pictures.

The neurosurgeon will later use computer images of the brain taken before and during the procedure and the patient's responses to make a map of the functional areas of the brain.

The neurosurgeon then removes as much of the tumor as possible while avoiding the functional parts of the brain. Throughout the procedure, the neuro-anesthesiologist will ensure that the patient does not feel any pain, monitor vital signs (heart rate, breathing and blood pressure) and talk to the patient to help them remain calm.

After any major operation, it takes a few weeks to recover fully. The results of an awake brain surgery will be given by your doctor.

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 little more simple exercise each day such as taking walks.

Your surgeon will usually arrange to see you in the outpatient’s clinic about 5 to 7 days after surgery to check on your recovery and also to give you any results from biopsies from the operation. He will also advise you on your further care and answer any other questions that you have.

Your clips or stitches will probably be removed in the clinic too.

What should you notify your doctor of, after surgery

Tell your doctor about:

• headaches that are progressively worsening
• fitting
• fever
• wound problems (increasing pain, swelling, discharge)
• development of new or worsening symptoms (weakness, numbness, etc)
• increasing drowsiness and rash

If you are at home you could discuss your symptoms with your GP, call your neuro-oncology specialist nurse (if you have one) or contact your surgeon and his team at the hospital. You will be given hospital phone numbers when you are discharged.