Sometimes the very best technology that we have is not the newest one. Awake craniotomies, also known as awake brain surgery, have been performed safely for decades and maybe even centuries if you count trephinations, which is a hole saw.
Awake craniotomy is a simple and elegant procedure performed on the brain while the patient remains awake and alert. This procedure has gotten better with modern pharmacology. What’s interesting is that the core principles of the procedure have remained the same since the early twentieth century.
Why Awake Brain Surgery Is Done
During a craniotomy, which is another name for brain surgery, the patient is awake and talking to the surgical team. As the team works through the procedure, they will ask the patient questions. The patient’s response lets the team know that they’re on the right track.
The brain is an amazing thing with many nerves. Those nerves pass through the spinal cord and branch throughout the body. Mapping these nerves during awake surgery is the only way to get feedback during the procedure. The team also monitors the brain’s activity.
This process reduces the chances of damaging important areas of the brain that control speech, language, movement, and other skills. The goal of the craniotomy is to remove as much of the tumor as possible and safely.
A patient with a tumor in the left frontal or temporal region such as this young lady that Dallas neurosurgeon Dr. Chris Michael operated on recently can be monitored for speech function while the tumor is removed under local anesthesia.
How Is Awake Craniotomy Done Without Feeling Pain?
Local anesthesia is one of the oldest forms of anesthesia and is adequate for opening the skull to remove a tumor. There’s no pain during the process because brain tissue doesn’t have pain fibers. The patient may feel vibrations or pressure during the surgery.
A local anesthetic allows surgeons to numb targeted areas of the brain. The team applies a local anesthetic to the skin, bone, and muscle that the surgeon will cut through to access the brain. The patient is awake anywhere from 45 minutes to several hours. The time depends on the size and complexity of the tumor.
Once the team has collected all the information they need from the patient, they will put the patient back to sleep. During this time, the team will close the incision.
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