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                     Awake Brain Surgery- A Fact and not a Fiction!

What is Awake Brain Surgery (Intraoperative brain mapping)?

Neurosurgeons perform many brain tumour procedures while the patient is awake but sedated called Awake Brain Surgery. An Awake brain surgery is to treat some brain (neurological) conditions, including some brain tumours or epileptic seizures. It enables the neurosurgeons to get rid of tumours that might rather be inoperable because:

· They are on the brink of areas of the brain that control vision, language and body movements

· The surgery may result in a loss of these functional areas.

When the tumours have spread throughout the brain without borders (sorts of glioma), awake brain surgery is performed. An Awake brain surgery can shrink these tumours. During the surgery, your surgeon asks you questions and accordingly monitors the brain activity as you respond. Based on your responses, your surgeon ensures that he or she is treating the correct area of your brain needing surgery. The procedure also lowers the danger of injury to functional areas of your brain that would affect your vision, movement or speech.

Why does it happen?

If a tumour or section of your brain that causes seizures needs surgical removal, doctors must make sure that they are not damaging a neighbourhood of the brain that affects your language, speech and motor skills. It is hard to pinpoint those areas exactly before surgery. An Awake brain surgery allows your surgeon to precisely know the particular areas of your brain that control these functions and avoids damaging them.

How an Awake brain surgery works?

·        Firstly, the neurosurgeon works very closely with the neuroanesthesiologist. Together, they will decide if awake brain surgery is appropriate for a particular patient, depending on:

· The importance of an Awake operation in removing the tumour without damaging critical parts of the brain

· Their general health (e.g., awake brain surgery is not advisable in patients with some types of sleep apnea and those who are obese)

· Whether the patient is going to be ready to remain calm during the procedure and answer the neurosurgeon

If an Awake brain surgery is recommended and the patient agrees, the neuroanesthesiologist will explain the procedure in privacy and answer their queries.

·        The neurosurgeon and neuroanesthesiologist will work together to work out the most appropriate anaesthesia for every patient.

·        The patient may be awake throughout the procedure: The patient will receive a nerve or scalp block — an injection of medication to block pain — and local anaesthesia — medicine to numb a small part on the scalp.

·         To start with, the patient will receive a scalp block, a little anaesthesia for sedation that makes the patient unconscious. The sedation stops and the patient is awake when the neurosurgeon is ready to remove the brain tumour. After that, the neuroanesthesiologist sedates the patient again and puts the patient to sleep.

·        During surgery, the neurosurgeon will stimulate the world around the tumour with small electrodes. To precisely locate the functional areas of the brain to be avoided, the neurosurgeon will ask the patient to perform tasks such as talking, counting and looking at pictures. Computer images of the brain are clicked before and during the procedure. The digital images and the patient responses help the neurosurgeon create a map of the functional areas of the brain. The neurosurgeon then removes the tumour as much as possible while avoiding the functional areas of the brain.

·        Throughout the procedure, the neuroanesthesiologist will make sure that the patient doesn't feel any pain. He/she monitors vital signs (heart rate, breathing, and blood pressure) and asks the patient to remain calm.

Risks may include:

· Changes in your vision

· Seizures

· Difficulty with speech or learning

· Loss of memory

· Impaired coordination and balance

· Stroke

· Swelling due to too much fluid in the brain

· Meningitis

· Leaking spinal fluid

· Weak muscles

Results

If you had awake brain surgery to manage epilepsy, that leads to improvements in your seizures after surgery. After the surgery, some people are seizure-free & some experience fewer seizures when compared to before surgery.

If you had an Awake brain surgery to remove a tumour, your neurosurgeon generally should have been able to remove most of the tumour. You may still need other treatments, such as radiation therapy or chemotherapy, to help destroy the remaining parts of the tumour.

For more information about problems associated with the spine contact Dr. Venugopal S. Or

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