Benefits of Awake Craniotomy

An awake craniotomy is a brain surgery performed in the same way as a conventional craniotomy, but with the patient awake during some phases of the procedure. This technique is especially indicated for operations to remove brain lesions that are near or within eloquent (functionally important) regions of the brain that are traditionally considered “untouchable”.
Performing the procedure while the patient is awake allows neurosurgery specialists to maximize the tumor resection margins, literally working in regions of the brain that are normally inaccessible due to their functional importance. This technique also allows us to determine that the patient’s neurological functions remain continuously intact during the procedure. The overall objective is, therefore, to minimize risks and ensure close to 100% tumor removal, while preserving the absolute integrity of the patient.

There are different procedures for performing an awake craniotomy, but they all share the same pattern: the anesthesia team applies sedation to the patient by means of an intravenous infusion that allows conventional general anesthesia while the skull is opened and the area where the tumor is located is exposed. In the operating room, a sophisticated neuro-navigation system determines the exact location of the tumor, allowing the incision to be marked in a precise and minimally invasive manner. Sometimes it is not even necessary to shave the incision area, as it is usually very small.
When the brain is exposed and the navigation system has identified the field of work, the patient is awakened and does not experience any pain or discomfort and can communicate perfectly well with all the members of the surgical team. It is then that a procedure called cortical mapping is performed: by means of bioelectrical stimulation of the brain surface with a small probe designed for this task, a “map” is obtained of the functionally active areas and of those that are not active due to tumor infiltration. The patient is the guide in this process, performing actions ranging from an answer to a specific question to writing, drawing or manipulating a computer or a musical instrument. In this way, the neurosurgeon knows whether he is dealing with a motor region of the brain, a sensory area or a tumor area.
After completing the mapping of these regions, the neurosurgeon carries out the removal of the tumor in a complete and satisfactory manner, while protecting the important regions of the brain during the entire procedure.
Postoperative recovery is generally much faster, as the patient has not been under prolonged general anesthesia. Sometimes, depending on the type of surgery, the patient may even be discharged the day after the operation.