Awake Brain Surgery

Brain Mapping Surgery at Mayo Clinic

Brain mapping procedure

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Brain mapping is an advanced neurosurgical procedure, or brain surgery, used to identify which areas of the brain control functions. It is typically used as a treatment option for patients with certain types of brain tumors or epileptic seizures in which the diseased tissue is next to areas of the brain which control the patient's vision, language and body movements. (Read more about candidates for awake brain surgery.)

At the beginning of the surgery, the patient is sedated and numbing medications are administered so that the patient feels no pain. During the procedure, the patient's head is placed in a comfortable, fixed position to keep the head still and ensure accuracy of the brain surgery.

At a specific time during the surgery, the patient is awakened. While the neurosurgeon stimulates the brain, the patient is asked questions by the speech pathologist or asked to make movements by the neurologist. The patient may be asked to look at cards and identify objects pictured on the cards, to count numbers or to raise a finger.

The medical team also uses three-dimensional computer images of the brain taken before and during the surgery as a guide in brain mapping. This is critical, because currently there is no good way to track these brain connections using just magnetic resonance image (MRI) scans.

The neurosurgeon then maps the brain by marking each area identified as functional brain.

During surgery, the neurosurgeon removes as much of the damaged brain tissue as possible, precisely guided by the computer images and the patient's responses.

Stereotactic radiosurgery is also an option for certain kinds of awake brain surgery.

In brain mapping surgery involving patients with epilepsy, the surgery may involve purposefully reproducing a seizure in the patient in a controlled setting to help map the brain and identify brain tissue that is affected by the epileptic seizures.

A critical factor in the patient's success in awake surgery is highly trained and experienced neuroanesthesiologists specifically trained in awake brain surgery who are experts in administering medications to ensure the patient feels no pain.

Surgical Team

Awake brain surgery involves a team of highly trained medical experts:

Neurosurgery: A neurosurgeon with extensive experience and expertise in awake brain surgery leads the surgical team.

Neuroanesthesiology: This is an anesthesiologist specialized in brain surgery who gives the patient anesthesia to put the patient asleep and reduce pain. The neuroanesthesiologist is specifically trained to keep the patient comfortable, yet alert enough to respond to tests evaluating the patient's brain functioning.

Neurology: A neurologist monitors and assesses the patient's body and brain functions during brain stimulation and alerts the surgeon if a function begins to be affected during surgery.

Speech pathology: A speech pathologist monitors the patient's language ability when the brain surgery is close to language regions of the brain. The tests administered to patients assess both reading and speech abilities during surgery.

Computer engineering: A computer engineer manages the computer-guiding systems to provide the neurosurgeon with accurate images of the patient's brain during surgery.

Language interpretation: Interpreters participate during surgery for patients who speak languages other than English and provide translation for the neurologist and speech pathologist to understand the patient's responses.