Awake Craniotomy

What is Awake Craniotomy?

Awake craniotomy is a type of brain surgery performed while the patient is awake and conscious. During the procedure, the surgeon removes a part of the skull to access the brain but leaves the outermost layer of the brain exposed. The patient is kept awake to allow the neurosurgeon to monitor brain function and ensure that no critical areas are damaged during the operation.

The patient is given a local anesthetic to numb the scalp and a mild sedative to help them relax. Once the skull is opened, the patient is asked to perform various tasks, such as speaking, counting, or moving their limbs, while the surgeon stimulates different areas of the brain with a small electrical current. This helps the surgeon to map out the brain and identify areas that control important functions such as speech, movement, and sensation. Awake craniotomy is often used to remove tumors or epileptic foci located near critical areas of the brain. It can also be used to treat other conditions, such as arteriovenous malformations or aneurysms.

Why and when Awake Craniotomy is recommended?

Awake craniotomy is recommended when a brain tumor or other abnormality is located near critical areas of the brain that control essential functions, such as speech, movement, or sensation. The procedure is used to remove the abnormality while minimizing the risk of damage to these critical areas.

Here are some specific scenarios where awake craniotomy may be recommended:

• Brain tumor removal: Awake craniotomy may be recommended to remove a brain tumor that is located near critical areas of the brain, such as the language or motor areas. By keeping the patient awake during surgery, the surgeon can map out these critical areas and avoid damaging them.
• Epilepsy surgery: If a patient has epilepsy that is not well-controlled with medication, they may be a candidate for epilepsy surgery. Awake craniotomy may be recommended to remove the portion of the brain that is causing the seizures, while avoiding damage to critical areas.
• Arteriovenous malformation (AVM) removal: An AVM is a tangle of abnormal blood vessels in the brain that can cause seizures or hemorrhages. Awake craniotomy may be recommended to remove the AVM while minimizing the risk of damage to critical areas of the brain.
• Aneurysm clipping: An aneurysm is a bulge in a blood vessel in the brain that can cause a stroke if it ruptures. Awake craniotomy may be recommended to clip the aneurysm while minimizing the risk of damage to critical areas of the brain.

The decision to perform an awake craniotomy is made on a case-by-case basis by a team of specialists, including a neurosurgeon, neurologist, and neuropsychologist.

How is Awake Craniotomy different from the conventional treatment?

Awake craniotomy differs from conventional brain surgery in several ways:

• Consciousness: The most significant difference is that the patient is awake during the procedure. This allows the surgeon to monitor brain function in real-time and identify areas of the brain that control critical functions, such as speech or movement.
• Mapping of the brain: The surgeon uses brain mapping techniques to identify and preserve critical areas of the brain. This is done by stimulating different parts of the brain with a small electrical current and asking the patient to perform tasks, such as speaking or moving their limbs. This allows the surgeon to identify areas that are critical for essential functions and avoid damaging them during the surgery.
• Anesthesia: During conventional brain surgery, the patient is typically placed under general anesthesia, which can carry risks such as respiratory problems, allergic reactions, or prolonged recovery times. With awake craniotomy, the patient is given a local anesthetic to numb the scalp and a mild sedative to help them relax. This reduces the risks associated with general anesthesia.
• Recovery time: Because awake craniotomy is a more targeted and precise procedure, the recovery time is often shorter than with conventional brain surgery. Patients may experience less pain and discomfort and can often return to normal activities more quickly. Overall, awake craniotomy offers several advantages over conventional brain surgery for certain types of brain tumors or abnormalities located near critical areas of the brain. It allows the neurosurgeon to perform a more precise and targeted surgery while minimizing the risks of damage to critical brain functions.

How is life after Awake Craniotomy?

Life after awake craniotomy can vary depending on the type and location of the brain abnormality and the extent of the surgery. However, here are some general things that patients can expect:

• Recovery period: After the surgery, patients typically spend a few days in the hospital to recover. The length of the hospital stay can vary depending on the extent of the surgery and the patient's overall health.
• Follow-up appointments: Patients will need to attend follow-up appointments with their neurosurgeon and other specialists to monitor their recovery and ensure that the surgery was successful.
• Rehabilitation: Depending on the location and extent of the surgery, patients may need to undergo rehabilitation to regain lost function, such as speech or movement. This can involve working with a speech therapist, physical therapist, or occupational therapist.
• Medications: Patients may need to take medications to manage pain, prevent seizures, or manage other symptoms after surgery.
• Emotional support: Going through a major surgery can be emotionally challenging, and patients may benefit from talking to a therapist or counsellor to help them cope with any anxiety, depression, or other emotions.

In general, most patients can return to their normal activities within a few weeks or months after awake craniotomy. However, recovery can vary depending on the individual and the extent of the surgery, and it's important for patients to follow their doctor's advice and take any necessary precautions to ensure a safe and successful recovery.