At Mayo Clinic, brain surgeons (neurosurgeons), doctors who have training in brain conditions (neurologists), anesthesia specialists, speech specialists (speech pathologists), computer engineers, language interpreters and other specialists work closely to care for you before, during and after awake brain surgery. Doctors first will determine if you're a candidate for the procedure, based on your condition.
In awake brain surgery, also called an awake craniotomy, a doctor sedates you with localized anesthesia and gives you numbing medications so you won't feel any pain. During the procedure, doctors place your head in a fixed position to keep your head still and ensure the accuracy of the surgery. Your surgeon then removes part of your skull to reach your brain. You're awake during most of the surgery, but you'll be sedated and asleep while part of your skull is removed in the beginning of the surgery and also when doctors reattach this part of your skull at the end of the surgery.
If your brain tumor or epileptic focus is close to areas of your brain that control speech and movement, your doctor will conduct brain mapping. Doctors perform brain mapping to precisely identify and mark these functional areas of your brain. Your surgeon also can perform brain mapping deeper in your brain during surgery, if necessary. Brain mapping, along with three-dimensional computer images, helps your surgeon remove as much of your brain tumor or epileptic focus as possible, and lower the risks of damaging your important body functions as a result of the surgery.
During surgery, a speech pathologist may ask you questions or your doctor may ask you to make movements, identify pictures on cards, count numbers or raise a finger. Your responses help your surgeon to ensure the procedure doesn't disturb any functional areas in your brain. Your medical team also uses detailed three-dimensional computer images of your brain taken before and during your surgery, including intraoperative MRI and computer-assisted brain surgery, to guide removal of as much of the brain tumor or epilepsy focus as possible. Sometimes they perform stereotactic radiosurgery during awake brain surgery.
Your doctor carefully monitors and assesses your body and brain functions and alerts your surgeon if a brain function begins to be affected during surgery. After surgery, your surgeon may request an MRI to ensure that removal of the tumor or epileptic focus is complete.