Awake craniotomy is a specific neurosurgical technique in which the patient is kept awake and able to communicate and cooperate during a critical portion of the brain tumour resection, while remaining under partial anaesthesia for the remainder of the procedure. The reason it is used relates to the location of the tumour within the brain. The brain contains areas whose function is critical and irreplaceable: the motor cortex, which controls movement on the opposite side of the body, and the speech areas, which include Broca's area controlling the production of speech and Wernicke's area controlling the comprehension of language. When a tumour is located within or immediately adjacent to these eloquent areas, the neurosurgeon needs to know in real time whether the surgical dissection is approaching functionally critical tissue. Neuronavigation tells me where I am anatomically within the brain. Intraoperative neurophysiological monitoring provides electrical signals from the motor pathways. But the most sensitive and specific test of whether speech function is being preserved is to have the patient speaking and answering questions during the resection. If speech begins to deteriorate as dissection approaches a particular area, surgery stops at that boundary. The patient experiences the awake portion of the procedure, which typically lasts between thirty minutes and an hour, as a conversation with a neuropsychologist who tests naming, counting, and simple language tasks while I continue operating. Most patients are surprised by how manageable the experience is. The brain itself has no pain receptors, so surgical manipulation of brain tissue is not painful. The head is fixed and the scalp is anaesthetised. The awake portion allows me to maximise the extent of tumour removal while protecting the function that defines the patient's quality of life.
Written by Dr. Prashanth Alle, MBBS, ECFMG (USA), DNB (Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru), Consultant Neurosurgeon, Gudage Hospital, Bidar, Monday to Saturday. For appointments, call +91 84822 26841.
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