Awake brain surgery (also called awake craniotomy) is a modern technique that enables neurosurgeons to perform brain surgery while the patient is awake. Who is awake brain surgery performed for? What is the technique used in these surgeries? What is the benefit of performing them? How does the patient prepare for them? And everything you want to know about this operation in Turkey.
Why do doctors use awake brain surgery?
When performing surgery for brain tumors or epilepsy, it is essential to avoid damaging the areas of the brain responsible for language, movement, and sensation in the patient. Neurosurgeons know which parts of the brain are responsible for these functions (and where they are generally located). Still, the brain remains a unique structure for each person, with anatomical differences between people.
Depending on how close the tumor is to each of these areas, it may be necessary to create a clear map of the patient’s brain structure to ensure the success of the surgery and avoid any future problems, precisely determining the location of the part responsible for these functions.
What technology is used in awake brain surgery in Turkey?
This advanced surgical technique is now also being performed in Turkey under the supervision of a multidisciplinary medical team. Awake brain surgery relies on the use of:
- Intraoperative magnetic resonance imaging (MRI) allows for precise brain imaging, enabling neurosurgeons to navigate effectively during surgery.
- Brain mapping with electrical stimulation allows surgeons to create a functional map of the tumor-affected part of the brain.
- Intraoperative monitoring while the patient is awake, where the medical team monitors cognitive functions during the surgery, including movement, sensation, language, speech, and problem-solving abilities.
- Computer-assisted brain surgery, guided by a 3D brain map similar to GPS, allows neurosurgeons to safely remove as much of the tumor as possible, visualizing and removing hidden tumor areas not visible with standard MRI.
Read about deep brain stimulation surgery for Parkinson’s disease treatment.
What types of brain tumors require awake brain surgery?
Awake brain surgery is performed for any brain mass that arises inside or near the areas of the brain responsible for vital functions such as language, sensation, and body movement, regardless of the type. Today, neurosurgeons consider awake brain mapping the gold standard for identifying and preserving these critical areas in the brain.
The more the surgeon can remove a significant portion of the tumor, the better patient outcomes. Awake brain mapping remains the critical element in removing as much of the tumor as possible while preserving neurological functions.
Brain tumors that may require awake neurosurgery include glioma (advanced stage) and ependymoma. Performing awake brain surgery depends on many other factors besides the type of tumor, such as the size and location of the tumor, the patient’s health condition, and medical history.
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How is awake brain surgery performed?
During the procedure, the patient’s scalp is under local anesthesia to ensure they do not feel pain, and the anesthesiologist administers sedative medications to help the patient feel drowsy and fall asleep.
The patient’s head is placed in a fixed position to ensure it does not move during surgery. A portion of the hair is cut, and the neurosurgeon removes a part of the skull to access the brain. This step is performed while the patient is fully asleep and anesthetized to ensure their comfort and that they do not feel pain. Once the brain is exposed, the anesthesiologist stops administering the sedative medications to allow the patient to wake up.
Afterward, the neurosurgeon stimulates different brain parts by applying mild electrical currents to the tumor’s surrounding areas.
The patient will not feel any pain during the stimulation, but depending on the location of the tumor, it may cause different sensations, such as muscle contractions in the leg or hand, tingling in the face or foot, or disturbances in the patient’s ability to speak or comprehend.
The neurophysiology specialist will monitor the patient’s reactions throughout the procedure, helping to identify and protect critical brain areas during surgery and mapping the patient’s brain.
To do this, the neurophysiology specialist will ask the patient questions about their feelings and may request that the patient perform specific tasks such as counting, reading, naming objects shown in pictures, or raising a finger. Based on the patient’s response, the specialist will give the surgeon a brain map of areas to avoid.
Read more: Hydrocephalus or water on the brain in Turkey.
The patient remains awake during the procedure for 45 minutes to several hours, depending on the size and location of the tumor and the symptoms before the operation.
The medical teams use brain images before and during surgery, MRI images, computer-assisted brain images, and electroencephalography (EEG) to remove as much of the brain tumor or epileptic focus as possible.
Throughout the procedure, the anesthesiologist monitors the patient’s condition to ensure their comfort and that they do not feel pain. Once the tumor is removed, the anesthesiologist administers sedative medications to allow the patient to return to sleep for the rest of the procedure.
Read more: Brain tumor symptoms, causes, and treatment in Turkey.
What happens after awake brain surgery?
After the awake brain surgery, doctors will take new MRI images of the brain to ensure the entire tumor has been removed. A sample of the removed tumor tissue will also be sent for analysis to determine the type of tumor and the next steps in treatment.
The recovery time from awake brain surgery depends on several factors, including the location of the tumor. On average, the patient is discharged within 2-4 days. Before discharge, the care team will check the patient’s ability to resume daily activities such as walking, talking, dressing, and using the bathroom.
Complete recovery may take several weeks; during the first few weeks, the patient may feel tired and sleepy. Despite this, the doctor advises participating in some simple household tasks. The patient can return to work and other daily activities within six weeks to three months. The first follow-up appointment is scheduled 10-14 days after the surgery to check the wound, ensure complete recovery, and answer any other patient questions. The doctor may discuss biopsy results and guide the patient on the next phase of treatment, such as radiation therapy or chemotherapy.
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What are the risks of awake brain surgery?
Awake Brain Surgery carries the same risks as traditional brain surgery. The occurrence of these risks depends on the location, size, and type of the tumor, as well as the patient’s age and overall health.
The same risks exist, but the risk of long-term complications that may cause permanent neurological disability (such as difficulty speaking or moving) is uncommon and occurs in less than 2-3% of cases. This is the purpose of performing awake brain surgery.
Risks include:
- Temporary or permanent neurological deficit
- Seizures
- Hematoma
- Infection and meningitis
- Vision changes if the responsible center is damaged
- Speech and learning disorders
- Memory loss
- Balance difficulties
- Stroke
- Muscle weakness
Awake brain surgery has made significant advancements in the field of neurosurgery. It is performed in Turkey under the supervision of experts in neurology and neurosurgery, with comprehensive care and follow-up for the patient’s condition before and after treatment.
Bimaristan Medical Center is your first choice for treatment in Turkey. We guide you to the best specialists in all fields, breaking the language barrier with Arab-speaking doctors who will help you communicate with your doctor. We assist in booking appointments at the most important and advanced treatment centers in Turkey, offering hotel reservations and transportation services for you and your companions. We also help you secure a free travel visa. We accompany you step by step toward recovery. Free consultations are always available. Don’t hesitate to contact us; we at Bimaristan are your family in Turkey. You can also read about Turkey’s latest techniques for treating spinal disc problems on our website.
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