Imagine being able to talk to your doctors during brain surgery without pain and give them immediate feedback if you feel any problem while they operate. That’s exactly what happens during an awake craniotomy or awake brain surgery. This high-end case was recently performed at Wockhardt Hospital, Nagpur.
This highly specialized surgical procedure requires a team approach led by a neurosurgeon and a neuroanesthesiologist which was performed by Dr. Rahul Zamad, Neuro Surgeon and Awantika Jaiswal, Neuroanesthesiologist.
“The main goal in such surgery is to remove as much of the tumor as can be removed, in the safest possible way. When a tumor is near an area of the brain that controls critical functions — such as speech, language, or movement — an awake craniotomy is the best way to identify and safely preserve those abilities”, informed Dr. Rahul Zamad.
Certain functions are generally located in particular areas on the brain’s surface. But below the surface, bundles of nerves pass through the brain to the spinal cord and throughout the body. During the surgery, we have to map these nerves using brain mapping gadgets to understand which ones are connected to key functions so that we can avoid them as we remove the tumor. Damaging critical nerves could cause permanent disability.
Awake craniotomies are frequently — but not always — used for various brain tumors which tend to occur in the frontal, parietal and temporal lobes, which control speech and motor function, and also for certain seizure disorders.
The most important player of the procedure is the patient as he has to feel comfortable with the idea of waking up during surgery. A patient with severe symptoms may not be able to effectively contribute to the neurological exams during surgery.
Brain tissue doesn’t have any pain fibers, so while you may feel pressure or vibrations from the surgery, you shouldn’t feel pain. We use a combination of local anesthetic and a small amount of sedation if required to numb the muscles, skin, and bone that the surgeon has to cut through to get to the brain. The patient is then completely awake while the resection of the tumor is started.
When the patient wakes up he will hear the neuroanesthesiologist reassuring the patient and though he won’t be able to move the head, the neuroanesthesiology team will make them as comfortable as possible and stay with the patient the entire time as it may require something from a few minutes to several hours to complete the procedure.
While being awake patient helps to map the areas of the brain by letting the team know about weakness in limbs or difficulty in speech. In our case, the area of interest was the motor and the premotor cortex. The neurosurgeon stimulates the part of your brain near the tumor by sending a light electrical current down the nerves. At the same time, the neuroanesthesiologist will give you some simple verbal tasks to see if the stimulation affected your neurological function, and the rest of the time also active communication continues.
Finally, when intracranial work is done and the patient’s condition is stable, the patient is again sedated and the rest of the procedure is completed.