Awake Craniotomy

An awake craniotomy is a brain tumor surgery where you are awake during part of the procedure. The surgery team can then interact with you, allowing them to identify and preserve key parts of the brain while removing the tumor.

What diseases are treated with awake craniotomy?

Awake craniotomies are used to treat patients with tumors in the parts of the brain that control speech, language, movement and sense of touch. Common tumors that grow in these areas include gliomas such as glioblastoma, astrocytoma and oligodendroglioma. Patients with any type of tumor in these locations may be eligible for an awake craniotomy, though.

Who are candidates for awake craniotomy?

An awake craniotomy is a major surgery. In addition to having a tumor in one of these important parts of the brain, you must be in good overall health to undergo this procedure.

If the location of the tumor and your health make you a candidate for an awake craniotomy, you will be evaluated by a neuropsychologist. These doctors specialize in identifying, diagnosing and treating changes in a person's ability to think, personality, behavior and mood. The neuropsychologist will give you a cognitive test to find out how your brain is performing and what parts may be impacted by your tumor. This test can help determine if an awake craniotomy is right for you.

You must also be willing to be awake during brain surgery. Your care team will work to ensure your comfort, but an awake craniotomy can be psychologically and physically more stressful than surgeries where you are completely asleep. Some patients decide not to have an awake craniotomy to avoid this stress.

What happens during an awake craniotomy?

If your care team recommends an awake craniotomy, there are several steps you’ll go through during the procedure.

1. Anesthesia: A specially trained neuro-anesthesiologist will give you anesthesia, so you will be asleep during the first part of the surgery. You will also get local anesthesia to the part of the scalp surrounding the incision.
2. Accessing the tumor: The surgeon will open the scalp and remove a part of the skull bone over the tumor. This lets the surgeon access the brain and the tumor. The surgeon will use specialized devices to keep the size of the cut as small as possible. The surgeon will also inject local anesthesia into the covering of the brain, called the dura, to help prevent any pain.
3. Waking the patient: The neuro-anesthesiologist will slowly wake you up from the anesthesia. You will not experience any pain when you wake up. You will be able to speak and to move your arms and legs.
4. Testing and mapping: Once you are fully awake, you will be asked to perform simple tasks. These can include counting backwards, naming objects projected on a screen, completing sentences and moving your limbs. You may even be asked to perform tasks from your daily life, such as playing a musical instrument.  While performing these tasks, the neurosurgeon will use an electric current to stimulate parts of the brain near the tumor. If you cannot perform a task during the stimulation, the surgeon will know that spot is responsible for the function being tested. This process lets the surgeon map the functions of the brain over and around the tumor. Testing and mapping can take anywhere from 10 minutes to several hours.
5. Tumor removal: During this step, the surgeon will use MRI images of the tumor and information from the testing and mapping to remove as much of the growth as possible without harming the functional parts of the brain. During and after the tumor is removed, the surgeon will test you to ensure you have your normal functions.
6. Closing the incision: The surgeon will close the dura, replace the skull and close the skin. During this part of the surgery, you will be either awake but sedated or fully asleep.

After the procedure, you will stay in the hospital for several days. You should be able to walk the day after surgery and return to most normal activities after several weeks. Full recovery can take several months.

What are the side effects of awake craniotomy procedures?

As with any surgery, there are potential risks and side effects associated with awake craniotomy, including:

• Bleeding
• Infection
• Post-surgery seizures
• Impairment of movement or speech: While awake craniotomy is designed to prevent these changes, in some cases the patient’s speech or movement is still impacted.  These changes may be temporary or permanent.

If you experience any side effects, talk to your care team. They can help you manage the neurological and physical effects of an awake craniotomy.

Awake craniotomy at MD Anderson

Awake craniotomies are complex procedures that require a team of experts. At MD Anderson, your care will include doctors who specialize in complex brain surgeries and preserving your quality of life.

The surgery itself is performed by an MD Anderson neurosurgeon. Our neurosurgeons are widely viewed as among of the best in the nation. They perform more than 2,000 procedures a year. Among these are hundreds of highly complex procedures like awake craniotomies. This gives our neurosurgeons incredible skill and expertise to call on when performing your surgery.

The surgery team will also include a dedicated neuro-anesthesiologist. This doctor is specially trained in managing anesthesia for brain surgery patients. The neuro-anesthesiologist will help you sleep at the start of the surgery, then slowly and carefully wake you up for the brain testing and mapping.

The team also includes a neuro-psychologist, who will perform the pretreatment assessment and will help test your neurological functions during the procedure.   

And at MD Anderson you will be surrounded by the strength of one of the nation's largest and most experienced cancer centers. From support groups to integrative medicine care, we have all the services needed to treat not just the disease, but the whole person.