Treatment at Mayo Clinic

By Mayo Clinic Staff

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At Mayo Clinic, a team of doctors and other specialists work closely to care for you before, during and after awake brain surgery.

Before surgery

Doctors first will determine if you're a candidate for the procedure, based on your condition. Doctors will also explain what to expect during the procedure and discuss the benefits and risks of awake brain surgery.

Awake brain surgery offers many advantages. People who have brain tumors or seizure centers (epileptic foci) near the functional brain tissue, whose conditions previously may have been considered inoperable, may have the option of awake brain surgery.

Also, awake brain surgery can minimize your risk of complications or damage to functional brain tissue.

Awake brain surgery may reduce the size of spreading brain tumors, and it may prolong your life and improve your quality of life.

As with any brain surgery, awake brain surgery has the potential for risks and complications including bleeding, infection, brain damage or death.

Other surgical complications may include nausea, vomiting or seizures.

Before surgery, a speech-language pathologist may ask you to identify pictures on cards. During the surgery, the speech-language pathologist will ask you to identify pictures on cards and compare your answers to your pre-surgery responses.

During surgery

In awake brain surgery, also called an awake craniotomy, an anesthesia specialist (anesthesiologist) will give some sedating medication while your neurosurgeon will apply numbing medications to your scalp to ensure your comfort.

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. However, 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 vision, 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 3-D computer images, helps your surgeon remove as much of your brain tumor or epileptic focus as possible and lower the risks of damaging important body functions.

During surgery, a speech-language 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 ensure the procedure doesn't disturb any functional areas in your brain.

Your medical team also uses detailed 3-D 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 anesthesiologist and surgical team 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

After surgery, your surgeon may request an MRI to ensure that removal of the tumor or epileptic focus is complete.

You'll spend about an hour in the post-anesthesia care unit after surgery and stay in the intensive care unit overnight. After surgery, you'll generally spend three to five days in the hospital.

You generally may return to work and normal activities in six weeks to three months. You'll have a follow-up appointment with your doctor about three months after surgery.

Mar. 19, 2014