Brain surgery while awake (also called awake craniotomy) is a modern technique that enables neurosurgeons to perform operations on the brain while the patient is awake. Know about this process in Turkey.
Why do doctors use brain surgery technique while awake?
When surgery for brain tumors or epileptic seizures It is necessary to avoid damaging the areas of the brain responsible for language, movement, and sense of the patient. Doctors and neurosurgeons know which parts of the brain are responsible for these functions (and where they are generally located), but the brain remains a unique structure for each person and there are anatomical differences between people.
Depending on how close the tumor is to each of these areas, to ensure the success of the operation and avoid any future problems, it may be necessary to clearly map the patient's brain structure and precisely locate the part responsible for these functions.
What technology is used in awake brain surgery in Turkey?
This advanced surgical technique is now also performed in Turkey under the supervision of a multidisciplinary medical team.
Brain surgery with wakefulness is based on a procedure:
- MRI during surgery. Which allows accurate imaging of the brain, enabling neurosurgeons to get a good orientation during surgery.
- Mapping the brain by electrical stimulation.Surgeons were able to map the functional part of the brain that is affected by the tumor.
- Vigilant observation during surgery.The medical team monitors neurocognitive functions during the procedure, including: movement, sensation, language and speech, solving complex problems.
- and computer-assisted brain surgery.Guided by a GPS-like 3D brain map, the latest technology allows neurosurgeons to safely remove as much of the tumor as possible, seeing and removing hidden areas of tumor not visible on a regular MRI.
What types of brain tumors require vigilant brain surgery to treat?
Awakening brain surgery is performed for any brain mass that arises in or near areas of the brain responsible for important vital functions such as language, sensation, and body movement, regardless of type. Today, brain and neurologists consider waking brain mapping to be the gold standard for identifying and preserving those vital areas of the brain.
The more a doctor can remove a larger section of the tumor, the better it will give patients, and vigilant brain mapping remains the critical component of removing as much of the tumor as possible while preserving neurological functions.
The types of brain tumors that may require this type of surgery are glioma (advanced stage) and ependymoma. Whether awake brain surgery is performed depends on many other factors, regardless of the type of tumor, such as the size and location of the tumor, the patient's health and medical history.
How is Awake brain surgery performed?
During the operation, the patient's scalp is under the influence of local anesthesia to ensure that he does not feel pain, and the anesthesiologist gives sleeping medicines to help patients feel sleepy and sleep.
The patient's head is placed in a fixed place to ensure that it does not move during the surgery, a portion of the hair will be cut and the neurosurgeon will remove a portion of the skull to reach the brain. This step will be done while the patient is fully asleep and anesthetized to ensure that he is comfortable and does not feel pain.
Once the brain is exposed, the anesthesiologist will stop administering the hypnotic drugs to allow the patient to wake up.
Then the neurosurgeon and brain will stimulate different parts of the brain, by applying mild electrical currents to the areas around the tumor.
The patient will not feel any pain during the stimulation, and depending on the location of the tumor, this stimulation causes different sensations such as contraction of the muscles of the leg or hand, a feeling of tingling in the face or feet, or a disturbance in the patient's ability to speak or absorb.
The neurophysiologist will monitor the patient's reactions throughout the procedure, to help identify and protect important areas of the brain during surgery and map the patient's brain.
To do this, the neurophysiologist asks the patient questions about how he feels and may ask the patient to complete certain tasks such as counting, reading, naming objects whose pictures are shown to him, or raising his finger.
The patient is awake during the operation for a period of 45 minutes (or an hour) to several hours, depending on the size and location of the tumor and symptoms before the operation.
Medical teams use brain imaging before and during surgery, magnetic resonance imaging, computer-assisted brain imaging, and electroencephalography (EEG) to remove as much of the brain tumor or tumor as possible. Focal epilepticus.
Throughout the operation, the anesthesiologist monitors the patient's condition to ensure his comfort and lack of pain. Once the tumor is removed, the anesthesiologist administers hypnotic drugs to bring the patient back to sleep for the rest of the procedure.
What after brain surgery while awake?
After surgery, doctors will take new MRI images of the brain to make sure all of the tumor has been removed. It will also send a sample of the tumor tissue removed for analysis to find out the type of tumor and to know the next treatment steps.
The recovery time from the awake brain process depends on several factors, including the location of the tumor. On average, the patient is discharged from the hospital within 2-4 days. Before that, the care team will check the patient's ability to resume daily activities such as walking, talking, getting dressed and using the bathroom as well.
Full recovery may take a few weeks; During the first weeks, the patient feels tired and wants to sleep, although the doctor advises him to participate in some simple household tasks. He will be able to return to work and other daily activities within 6 weeks to 3 months. The date of the first review 10-14 days after the operation to examine the wound and make sure the doctor has made a full recovery and answer the patient’s other inquiries. The doctor may discuss the results of the biopsies and direct the patient to the second stage of treatment such as radiotherapy or chemotherapy.
What are the risks of brain surgery while awake?
Brain surgery while awake carries the same risk as brain surgery if it's done in a traditional way. The occurrence of these risks depends on the location, size and type of the tumor, as well as the patient's age and general health.
The risks are the same but the risk of long-term complications that may cause permanent neurological deficits (such as difficulty speaking or moving) is uncommon and occurs in less than 2-3 % cases. This is the purpose of brain surgery during wakefulness.
Risks include:
- Temporary or permanent neurological deficit
- epileptic seizures
- hematoma
- Meningitis infection
- Changes in vision in case the center responsible for this is damaged.
- Speech and learning disorder
- memory loss
- Balance difficulties
- Stroke
- muscle weakness
Alert brain surgery has made great progress in the field of neurosurgery, which is being performed in Turkey, under the supervision of experts in neurosurgery and diseases, while providing comprehensive care and follow-up of the patient’s condition before and after treatment.
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