Performing surgery to remove a brain tumor while the patient is awake is an emerging surgical approach performed by specially trained neurosurgeons that allows the removal of the greatest amount of tumor with the least amount of damage to healthy brain tissue and functioning. It’s a procedure called awake craniotomy.
“Keeping the patient awake during brain tumor removal allows us to test critical portions of the brain that might be affected by resection,” says Dr. Angela Bohnen, a fellowship-trained neurosurgeon with Neurosurgery One. “It allows us to map brain function around the tumor—such as areas affecting speech, movement and spatial orientation—so that we can stay clear of those areas while resecting as much of the tumor as possible.”
The technique requires specialized training, with Dr. Bohnen being one of only a couple neurosurgeons in all of Denver to offer it. She practices at Neurosurgery One in Littleton and Lone Tree, Colo., serving patients with brain tumors from throughout the Denver metro area.
How Awake Brain Surgery Works
Awake craniotomies are performed while the patient is awake — but there’s no pain involved because the brain does not have pain receptors, Dr. Bohnen says. Patients are given a scalp block and put under sedation while the skull is opened and the tumor accessed. Then the anesthesia is taken off and the patient wakes fully.
“That’s when we map the brain by asking the patient to do certain tasks — whether movement tasks, reading tasks, naming tasks, different spatial tasks—while we provide electrical stimulation to the brain,” Dr. Bohnen says. “When we have that map of the surface of the brain, we can then plan our approach to the tumor removal. While we’re removing the tumor, we continue to have the patient participate in those same tasks. We continue to stimulate at the depths and the borders — looking for changes in the patient’s exam. That’s what allows us to take the resection as far out as possible.”
Once the tumor is removed, the patient is once again sedated while Dr. Bohnen finishes the closure.
This technique received widespread news coverage earlier this year when a London neurosurgeon used it to remove a tumor from the brain of a violin player while she played her instrument in the operating room.
The Benefits of Awake Brain Surgery
Awake brain surgery for brain tumor removal has several benefits over traditional techniques, not the least of which is being able to remove more of a tumor without negatively affecting brain function. Other benefits include less anesthesia, a shorter hospital stay, and a lower cost, Dr. Bohnen says.
“It allows us a way to approach tumors that were once thought to be inoperable,” Dr. Bohnen says. “And it’s proving successful in prolonging survival as well as extending the progression-free time zone for patients.”
Who Is a Good Candidate for Awake Craniotomy?
Awake brain surgery for tumor removal is becoming more common, but it’s not for everyone. The technique is most frequently used in patients who have intrinsic tumors deep within the brain, but some patients with tumors that are outside the brain that may be pushing on critical portions may be candidates as well. After talking to a patient and performing a neurological exam, Dr. Bohnen then determines if awake brain surgery is an option. Using this technique also depends on the patient’s personal preferences and comfort.
“Awake craniotomy is a misnomer that can scare a patient up front,” Dr. Bohnen says. “I prefer to describe it as ‘sedated’ craniotomy. Some patients thrive on the ability to participate in the procedure as it gives them some control of their situation. At the end of the day, if a patient is extremely anxious about it, they aren’t a good candidate and alternative techniques can be used, such as asleep brain mapping.”