Awake craniotomy is a neurosurgical technique that allows for the removal of brain tumors while the patient is awake, minimizing the risk of brain damage by mapping vital brain areas. The procedure involves anesthesia and a neuronavigation system to locate and protect critical regions, with continuous monitoring of the patient's functions during surgery. A specialized method called awake speech mapping is used to identify important speech areas by stimulating the brain to ensure these regions are not disturbed during tumor removal.

1. AWAKE CRANIOTOMY
SURGERY

2. WHAT IS AWAKE CRANIOTOMY?
As the name suggests, Awake Craniotomy is a
neurosurgical technique used to remove a brain tumor
while the patient remains awake to avoid brain damage. In
this process of surgery the neurosurgeon performs cortical
mapping to locate vital areas, referred to as 'eloquent
brain' which should not be disturbed while removing the
tumor. This process of craniotomy is a preferred technique
to operate and remove lesions involving eloquent or
functionally important parts of the brain.

3. IMAGE: AWAKE CRANIOTOMY

4. This procedure allows the surgeons to test regions of
the brain before they are incised or removed. It also
allows to test the functions of the patient throughout
the process of operation. The overall motive behind
such surgery is to minimize the risks involved with
such operations.

5. HOW IT IS PERFORMED
In Awake Craniotomy the patient is taken to the
anesthetic room where they will have a drip inserted
with some drugs making them feel comfortable and
relaxed. Then in the operation theatre,
neuronavigation system is used to mark out the
incision. A very small amount of hair is shaved across
the line of the incision and then cleaned with
antiseptic solutions. After this local anaesthetic is
inserted around the incision. In the beginning, it stings
for a few seconds and then go numb.

6. The surgeons then place some drapes around the wound while
you will be able to see the anesthetic team, you will be able to
move your arms and legs without any obstacle during the
operation. While the operation process continues, for a brief
period of time you will hear some noises and the drilling
sound.
After mapping out the eloquent regions of the brain to
avoid and save, the doctors remove the tumors. In this process,
doctors constantly keep testing the patient's function and in
case anything happens, they can stop it immediately.

7. GENERAL INFORMATION ABOUT
AWAKE CRANIOTOMY
 When a tumor is near critical speech areas of the brain, it may be
important to determine the exact location of these speech-related
areas.
 Although functional MRI (fMRI) can show the various areas of
activation during speech functions, it does not pinpoint the most
important areas. These critical areas must be located using special
speech mapping techniques while the patient is awake in the
operating room.
 Awake speech mapping involves applying mild electrical current to
the surface of the exposed brain while the patient performs various
tasks, such as reading. If the stimulation hinders the task, then that
area of the brain is marked and preserved.

8. KEY POINT – HOW IT WORKS
 UCLA has pioneered the technique of sleep-awake-sleep
craniotomy.
 The operation is begun while the patient is deeply asleep
under general anesthesia (on a breathing machine). This is
for the comfort of the patient and is safer.
 When the brain is exposed and the neurosurgeon is ready
to begin mapping the speech areas, UCLA
neuroanesthesiologists carefully lighten the sedation, and
then remove the breathing tube and allow the patient to
talk and interact with the neuropsychologist.

9.  Typically, the patients feel minimal or no discomfort while
awake
 Once the speech mapping is complete, often the tumor is
removed while the speech testing continues. The procedure
lessens the risk of undercutting the white matter fibers
connecting speech areas.
 When appropriate, the anesthesiologist skillfully places the
patient back under general (deep) anesthesia, allowing the
neurosurgeon to complete the operation safely with no
discomfort to the patient.

10. For More Detail & Consultation
Please Visit
www.cnsneurosurgery.com.au