An Introduction to Innovative Brain Surgery Beyond Conventional Surgical Treatments

Beyond conventional surgical treatments, awake brain surgery presents the intersection of precision, real-time feedback, and medical innovation. In this blog, we will discuss the intricacies of awake brain surgery, exploring its transformative potential in treating complex brain conditions.

What is Awake Brain Surgery?

Awake brain surgery, also known as awake craniotomy, is a specialised surgical approach used to treat brain tumours, epilepsy, and other neurological conditions. Unlike conventional surgeries that are performed under general anaesthesia, awake craniotomy involves keeping the patient awake and alert during certain phases of the procedure. This allows the neurosurgeon to interact with the patient in real-time, enabling precise mapping and preservation of critical brain functions.

How Does Awake Craniotomy Work?

The process of awake craniotomy typically unfolds in several stages:

1. Anaesthesia & Sedation

   To begin the procedure, the patient is initially administered with local anaesthesia followed by sedation to induce a state of unconsciousness. Once the skull is opened and the brain is exposed, the sedation is stopped to allow the patient to regain consciousness gradually.

2. Brain Mapping

   With the patient awake, the neurosurgeon uses techniques such as direct electrical stimulation or functional MRI to map vital areas of the brain responsible for functions such as speech, movement, and sensation. During this process, patients are tasked with a series of tests guided by a neuropsychologist. These tasks include speaking, movement of objects, recalling information and more. With real-time feedback as such, neurosurgeons can map out parts of the brain to ensure perseveration of critical functions while removing or treating the targeted lesion.

3. Tumour Resection 

   With the brain mapped and critical areas identified, the neurosurgeon proceeds with the main objective of the surgery, whether it’s removing a tumour, treating epilepsy, or addressing other neurological conditions. Throughout this phase, the patient remains awake and responsive, providing invaluable feedback to the surgical team.

4. Closure

   Once the surgical objectives are accomplished, the sedation is adjusted again to deepen the patient’s level of sedation for the closure of the incision and completion of the procedure.

Benefits of Awake Brain Surgery

While it may seem daunting to be awake for brain surgery, there are several advantages to this approach. 

• Maximised Tumour Resection

  With the patient awake and responsive, the brain surgeon can distinguish between tumour tissue and healthy brain tissue with better accuracy. This facilitates maximal tumour removal while preserving critical functions such as language, speech and motor skills. 

• Immediate Feedback

  The patient’s ability to communicate during surgery allows for immediate feedback on any changes in neurological function. This enables prompt adjustments to ensure mapped out regions are left untouched, minimising the risk of functional deficits. 

• Maximising Quality of Life 

  Awake craniotomy allows the preservation of functionally essential brain regions such as motor functions, speech, memory and more. This ensures that patients can still retain the critical functions, maximising their quality of life post-surgery.

Conditions Treated with Awake Brain Surgery

Awake brain surgery is used to treat any lesions including brain tumours, cavernomas, arteriovenous malformation (AVM), or regions that involve eloquent segments of the brain. 

• Brain Tumours: Both benign and malignant brain tumours can be effectively treated with awake craniotomy, allowing for precise tumour resection while minimising damage to surrounding brain tissue and providing patients a better optimisation of onco-functional balance.  
• Cavernomas: This condition refers to when there is an abnormal cluster of blood vessels, found usually in the brain and spinal cord.
• Arteriovenous malformation (AVM): AVM refers to an abnormal tangle of the arteries and veins. As such, this condition disrupts the blood flow and oxygen circulation.

Closing Thoughts

Staying awake during surgery can sound intimidating. However, awake brain surgery, also known as awake craniotomy, is a surgical procedure that aims to maximise tumour removal whilst preserving critical functions. 

At Precision Neurosurgery, our director neurosurgeon Dr Teo Keija, has over 15 years of experience and specialises in brain mapping and awake brain surgery. He is well-equipped to treat brain, spine and certain nerve conditions.

Book an appointment here.