Awake brain surgery
Awake brain surgery refers to the kind of brain surgery in which the patient remains awake and communicates with the surgeon while being operated upon!
This kind of surgery is performed when there’s a risk of losing limb function or the ability to speak/understand after brain surgery.
In order to eliminate such risk the patient is kept awake and asked to communicate and move limbs while the surgery is on. If there’s an apparent change in these functions then the surgery can be modified appropriately.
Such surgeries require a very high level of expertise of both the surgeon and the anesthetist.
Indications:
- Resection of brain tumors: Awake brain surgery is commonly used for the removal of brain tumors located near critical areas of the brain, such as those responsible for language, motor function, and sensory perception. By keeping the patient awake, the surgeon can monitor brain activity and minimize the risk of damaging vital functions.
- Epilepsy surgery: In cases where epilepsy is not well controlled with medication, surgical intervention may be necessary. Awake brain surgery can be performed to identify and remove the epileptic focus while sparing essential brain regions responsible for speech, movement, and other critical functions.
- Brain mapping for tumor margins: In some cases, awake brain surgery is employed to precisely map the boundaries of a brain tumor. By stimulating different areas of the brain while the patient performs specific tasks, the surgeon can identify the functional regions and create a detailed map to guide the subsequent tumor removal.
- Deep brain stimulation (DBS) placement: Awake surgery is utilized in the placement of deep brain stimulation electrodes. This technique is commonly used for the treatment of movement disorders such as Parkinson’s disease, essential tremor, and dystonia. The patient’s feedback during electrode placement helps optimize the targeting and minimize adverse effects.
- Resection of arteriovenous malformations (AVMs): AVMs are abnormal tangles of blood vessels in the brain that can cause seizures, hemorrhages, or other neurological symptoms. Awake brain surgery may be employed to resect AVMs located near critical areas, allowing real-time monitoring to minimize potential damage.
- Resection of brain lesions near eloquent areas: If a brain lesion, such as a cavernoma or low-grade glioma, is located near essential regions of the brain, awake surgery might be considered to ensure precise removal while preserving neurological function.
It’s important to note that the decision to perform awake brain surgery is made on a case-by-case basis, and not all patients with these conditions will undergo this procedure.
Advantages:
Awake brain surgery, despite its unique nature, offers several benefits compared to traditional brain surgery performed under general anesthesia. Here are some of the benefits of awake brain surgery:
- Maximizing tumor resection: Awake brain surgery allows the surgeon to interact with the patient during the procedure, enabling real-time assessment of brain function. This feedback helps identify and protect critical brain regions, such as those responsible for language, motor control, and sensory perception. By minimizing damage to vital areas, the surgeon can maximize the extent of tumor resection while preserving neurological function.
- Accurate mapping of brain functions: Awake brain surgery provides an opportunity to accurately map the functional areas of the brain. By stimulating different regions while the patient is awake and performing specific tasks, surgeons can precisely identify the boundaries of critical brain regions. This information is crucial for planning the surgical approach and avoiding unnecessary damage.
- Reducing the risk of neurological deficits: With awake brain surgery, the surgeon can immediately detect any changes in brain function during the procedure. If a specific brain region is stimulated and causes a functional deficit, the surgeon can adjust the surgical plan accordingly to avoid permanent damage. This real-time monitoring helps reduce the risk of post-surgical neurological deficits, such as speech impairment, weakness, or sensory loss.
- Tailoring the surgery to individual patients: Awake brain surgery allows for a personalized approach to each patient. By interacting with the patient during the procedure, the surgical team can adapt the surgery based on the patient’s unique responses and needs. This individualized approach improves the precision and safety of the surgery.
- Enhancing patient safety and satisfaction: Awake brain surgery involves a collaborative effort between the patient, the surgical team, and the anesthesiologist. This shared decision-making process and patient involvement can enhance overall safety and satisfaction. The patient can actively participate in their care, express concerns, and provide crucial feedback during the procedure.
- Shortening hospital stays and recovery time: Awake brain surgery is associated with shorter hospital stays compared to procedures performed under general anesthesia. Since the surgery is more targeted and preserves critical functions, the recovery period may also be shorter. This allows patients to return to their normal activities and rehabilitation sooner.
It’s important to note that while awake brain surgery offers these benefits, it may not be suitable for all patients or all types of brain conditions. The decision to perform awake brain surgery is made based on careful evaluation by the surgical team, taking into account individual factors and the specific goals of the procedure.