What Is An Awake Craniotomy?

Some tumors are located close to sensitive areas of the brain. If surgery damages those areas, it can cause long-term neurological problems. In the past, neurosurgeons may have considered these tumors inoperable. Today, we’re able to treat many of them using awake craniotomy, also called awake brain surgery. 

During this procedure, you’re awake and able to give feedback. Your responses help the neurosurgeon map the function of surrounding tissues and avoid these essential areas.

The thought of being awake during brain surgery may be frightening. At Memorial Neuroscience Institute, you’re in the hands of a skilled, caring team. They work with you to help you understand what to expect and ease any concerns you have. 

Your team may include: 

• Neurosurgeons: Plan and perform brain tumor surgery. 
• Neuroanesthesiologists: Deliver anesthesia during surgery so you’re asleep and awake when needed and don’t feel pain. 
• Neuropsychologists: Evaluate brain function before, during and after surgery. Meet our neuropsychologists. 
• Neurocritical care specialists: Work in the hospital intensive care unit (ICU) to monitor you after surgery and treat any problems quickly.  
• Neuroradiologists: Perform imaging studies to assess brain tumors and plan for surgery. Learn more about neuroradiology.  

Brain Tumors We Treat With Awake Craniotomy 

We use awake craniotomy for brain tumors located in regions of the brain that control speech, sensation and movement. Many of these tumors are gliomas that start in the protective cells surrounding neurons.  

What Happens Before Surgery? 

Neurosurgeons plan their approach using 3D images of your brain. These images show the tumor size and location and help determine the best way to reach it. 

Before surgery, your neurosurgeon and neuroanesthesiologist meet with you to explain the procedure. They answer your questions and help you get used to the idea of awake surgery.

A neuropsychologist will also meet with you to assess speech, language, thinking and other brain functions. These tests help ensure you’re able to participate in surgery. They also serve as a baseline to detect any changes that occur after surgery.  

Anesthesia for Awake Craniotomy  

We use two types of anesthesia medications during awake craniotomy: 

• General anesthesia: Causes sedation (a temporary loss of consciousness) 
• Local anesthesia: Numbs your scalp and skull 

You receive general anesthesia during the first and last parts of the procedure. During the middle part — brain mapping — the anesthesiologist reduces the sedation. Doing so allows you to wake up and talk to the surgical team. 

While you’re awake, the local anesthesia blocks any pain from the incisions. You may feel pressure or vibrations during the operation, but it shouldn’t be painful. 

What Happens During Awake Craniotomy?

The first step in awake craniotomy is to place your head in a fixed frame to hold it still. While you’re asleep, the neurosurgeon removes a small section of your skull to access your brain.

After waking you up, the neurosurgeon and neuropsychologist work together to map brain function. This process involves stimulating areas around the tumor with a mild electrical current while monitoring your response. 

You may experience tingling sensations, speech problems or muscle contractions. Those reactions tell the neurosurgeon which areas to avoid. 

With that information, the neuroanesthesiologist increases the sedation to allow you to sleep for the rest of the procedure. The neurosurgeon removes the tumor, replaces the bone using plates and screws, and closes the incision.  

Recovery After Awake Craniotomy 

We provide monitoring and care after surgery to help you return to your daily life. Our care includes:

Awake Craniotomy: Why Choose Memorial Neuroscience Institute? 

Awake craniotomy is a highly specialized surgical procedure that’s not widely available in South Florida. When you come to Memorial Neuroscience Institute for brain tumor care, you’ll find:  

• Skilled, coordinated team: Our fellowship-trained neurosurgeons and neuroanesthesiologists have extensive experience in brain surgery. They work closely with the rest of the surgical team to deliver streamlined care throughout your journey. 
• Commitment to quality: Our neurosurgeons meet routinely to discuss cases and review treatment plans. They share suggestions and strategies for improving the safety of surgery and patient outcomes. 
• Hair-sparing techniques: Shaving your hair is usually not a requirement for brain surgery. When needed, we keep the shaved area as small as possible so it’s barely visible. 
• Helpful navigation: You have access to a navigator to guide you and your family through surgery and recovery. They provide guidance, answer questions and help you with any issues that might arise.  
• Same-day appointments for new diagnoses: We offer timely appointments for people with new brain tumor diagnoses so we can start planning treatment right away. 
• Personalized approach: Your condition is unique, and your treatment should be too. Our neurosurgeons listen to you and tailor your treatment to fit your needs and preferences. 
• Exceptional cancer care: Depending on the tumor type, awake craniotomy may be part of cancer treatment. Memorial Cancer Institute is a leading cancer center in the region, providing the latest cancer treatments and compassionate support services.