Neuro Sciences

Awake Craniotomy

  • Awake Craniotomy

A surgical procedure for tumour close to the functionally important part of brain

– By Dr. Manish Kumar MBBS, DNB (Neurosurgery)

An awake craniotomy is a surgical operation carried out similarly to any conventional craniotomy however in this surgery the patient is awake during the procedure. Awake Craniotomy is one of the most preferred techniques for operations for excision of tumors which involve or are close to the eloquent regions of the brain. This technique of craniotomy allows the neurosurgeons to test the brain region before incision / excision along with a regular check on the patient’s functionality during the surgery. An awake Craniotomy minimizes the risk for the patient during the operation.

Awake Craniotomy Process

A drip is inserted in patient’s body for the purpose of giving local anesthesia when the patient is in the anesthetic room. The local anesthesia comforts and relaxes the patient body after which the patient is taken to operation theatre where the Neuronavigation system is used to mark areas for incisions (cuts). Through the line incision, small amount of hair would be shaven off for clear incision and to avoid infection. The patient will be in a slightly numb state however being able to hear surrounding noises and move limbs. After the incision is done the brain area is exposed Cortical Mapping is performed.

“Establishing the relationship between various structures of the brain and their functions, Cortical Mapping is a technique used in neurosurgery to determine which parts of a diseased brain may be safely excised.”

http://medical-dictionary.thefreedictionary.com/cortical+mapping

Post operation and removal of tumour the bleeding is stopped the thick membrane around the brain is closed with the help of sutures. Mini plates are used to replace the bone flap and to close scalp. The skin is stapled to close the wound and apply a head bandage.

Post Awake Craniotomy

The recovery period is much shorter for the patients of awake craniotomy compared to conventional craniotomy. The patient is able to consume food and liquid and move around. The discharge is usually the same day after surgery or after a day once the neurosurgeon confirms. It takes few weeks to completely recover after any major surgery. In case of Awake Craniotomy, for first few weeks, the patient might suffer from headaches which can be controlled with general painkillers. There are chances of dizziness, and it is must to rest properly. A little exercise or walk is however generally preferred.

Consult your doctor in case, you see following symptoms:

  • Progressively worsening headaches
  • Fits
  • Fever & Rashes
  • Wound problems
  • Weakness or Numbness
  • Increasing drowsiness

Complications after Awake Craniotomy Surgery

The risks for the Awake Craniotomy are similar to that of conventional surgery, however there is also a chance of seizures during the surgery which might require the awake surgery to be transformed into conventional surgery with general anesthesia. Surgeries are always risky and while the awake surgery is considered to be a safer option, the slight risk involved depends on the factors like size, location and the type of tumour along with patient’s generic health and medical history.

Complications after awake surgery include, however not exclusive to:

  • Temporary or permanent paralysis of limbs or loss of speech
  • Blood clot
  • Brain swelling
  • Infection
  • Fits