Awake Craniotomy: Benefits, Preparation, and Complications

Awake brain surgery also known as Awake craniotomy is a process in which the patient is awake during the surgery. It allows surgeons to remove brain tumors without affecting functions like sensation, movement, and speech. What type of surgeon performs a craniotomy? Continue reading to know more about the awake craniotomy procedure.

Awake Craniotomy History

The patient was kept awake during the surgical procedure in an awake craniotomy. In ancient times, awake craniotomy was performed to remove morbid conditions and treat seizures. Recently, surgeons prefer awake craniotomy for most of the issues and to remove metastases and brain cancers.

In 1886, Sir Victor Horsley performed awake craniotomy. Brain surgeons in North America has been using this procedure since the 1980s followed by Europe and across Asia. In the 1920s, the modern phase of awake craniotomy started by Wilder Penfield. He cured the patients facing intractable epilepsy. Later, Archer followed this procedure for brain tumors in 1988. Nowadays, it is commonly used to map vital brain areas. 

Awake Craniotomy Benefits

There are a lot of benefits of awake brain surgery. Some of the advantages are given below. 

• Needed less monitoring and stay in the intensive care unit (ICU).
• Fewer neurological deficiencies are visible in the patients undergoing awake craniotomy.
• They have shorter hospital stays compared to patients who did craniotomy under general anesthesia. 
• General anesthesia is unnecessary for patients who go through awake craniotomy under sedation. 
• Symptoms like nausea, postoperative pain, and vomiting are less in awake craniotomy. 

Awake Craniotomy Preparation

Who performs awake craniotomy? It is performed by a neurosurgeon who works with a neurologist and an anesthesiologist. Other people present in the surgical room include an oncologist, speech therapists, neuropsychologists, and rehabilitation experts. Before a few days of surgery, blood tests, chest X-rays, physical exams and more must be undergone by the patient for safety. The physician will ask you not to drink or eat to avoid vomiting under sedation before surgery. 

The awake craniotomy procedure takes place around 4 to 6 hours depending on the patient’s condition. Firstly, appropriate anesthesia is given to the patient. Few surgeons prefer that patients should be awake during the tumor removal stage and others want them to be awake throughout the entire process. 

A three-pin skull clamp is fixed to the table once the patient is highly sedated. Later, local anesthesia will be applied to place a pin on the patient’s head. Pillows and other comfort measures are provided for patients to ensure their comfort. After setting the position, his/her hair is clipped or removed to perform the awake craniotomy procedure. 

Complications during Awake Craniotomy 

Is awake surgery safe? A few of the challenges of awake craniotomy are specified below. 

• Respiratory issues: Due to high sedation, airway obstruction may be experienced by patients. It leads to hypercarbia and hypoxia. 
• Vomiting and Nausea: Nausea is visible in 4% of patients who go through awake craniotomy. It is due to surgical stimulation and anxiety. Some drugs to manage vomiting and nausea include propofol, ondansetron, etc. 
• Seizures: It can happen at the time of brain mapping. Patients with a history of tumors and seizure are more likely to have seizures during the procedure. About 3 to 16% of seizure incidence occurs during brain mapping. 

You must consult the best surgeon before doing the awake brain surgery. A good surgeon informs you about the vital process of awake craniotomy that led to your better health and safety.