Neurologist Questions Awake Brain Surgery

Awake during brain surgery?

Is it really true that people are awake during brain surgery? If this is true, why is it necessary if at all?

11 Answers

Yes it is true, and it's necessary in cases where the pathology for example a tumor is close to a critically important part of the brain responsible for speech or motor control area where we want to maximize the removal and minimize the harm done to the patient. As such, being awake allows us to map this area and gives us a positive feedback as to whether we are causing harm or not, so it's very useful and we use it all the time.
True in specific cases.
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With certain types of brain surgery, when operating around very special areas of the brain, we will keep the patient awake to avoid causing deficits which would not be able to be tested should the patient be asleep.
yes it is true, in some surgeries patients need to convey what type of sensations they feel for more surgical precision.
It is important so that the patient can follow instructions regarding speech movement and cognitive tasks which can be affected during the surgery near elequent brain regions.

Very few brain operations are performed with a patient awake. This is done only in situations when a pathology in the brain is located in a dominant brain hemisphere (usually left) and close to eloquent brain areas (such as areas controlling your speech or movement). This is performed only to avoid a deleterious complication that would effect a patient's quality of life after surgery. However, patients are always put to sleep and woken up during surgery only after the area of the brain to be operated on is already exposed.
Awake brain surgery goes back to the early 1900s (Fedor Krause) and the 1920s and 30's (Wilder Penfield). Initially awake surgery was for treating epilepsy to map out brain function and see where seizures might be coming from. In the 1990s surgeons started doing this more frequently for brain tumors in areas close to speech and movement in order to electrically stimulate these brain areas to identify function and avoid damaging function when removing tumor and this has remained a gold standard today. Modern anesthesia makes it easier to wake up a patient just during testing as opposed to being awake for the whole procedure. Implanting electrodes for brain pacemakers for Parkinson's disease treatment is often done awake in order to test function, stimulate and record electrical activity. Local anesthetic is always used and the brain has no pain sensation. Patients do get tired doing tasks during testing though.
Awake cranial surgery requires the patient to be awake and aware during surgery. Usually patients are kept comfortable and sedated at the start of the case and adequate local anesthetic is injected in the scalp to numb the area where the incision is made.
Once the incision is made, bone is removed and the brain is exposed, the patient's sedation is lightened in order for the patient to communicate with the surgeon or speech therapist.
The patient is needed to be awake in surgeries that require working on parts of the brain that control speech and motor function. Therefore, the patient is usually awake as the surgeon stimulates and tests those areas before working on them. If stimulation of those areas results in speech arrest or paralysis (where patient is unable to talk during the surgery or move a limb), the surgeon would avoid those areas
Yes, some people are awake during brain surgery. The operation is generally done when the tissue to be operated on in the brain is near what we like to call eloquent areas of the brain generally associated with speech and motor functions. This allows the surgeon to avoid causing any postoperative deficits and to allow them to safely perform the removal of the tissue that needs to be removed. The brain itself does not feel pain which is what allows this to take place.
Yes is true, awake surgery is necessary to avoid neurological deficits
Not all brain surgery is performed with the patient being awake. Infact, most require the patient to undergo general anesthesia. There are some operations where "awake surgery" is helpful - i.e. some seizure and tumor surgeries which guide in minimizing postoperative defects.