Awake brain surgery is a type of procedure performed while you're awake to treat some brain (neurological) conditions, including some brain tumors or epileptic seizures.

If your tumor or seizure center (epilepsy focus) is near the parts of your brain that control vision, movement or speech, you may be awake during surgery to respond to your surgeon.

Your responses help your surgeon to ensure that he or she treats the precise area of your brain needing surgery. In addition, the procedure lowers the risk of damage to functional areas of your brain.

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.

  • Experience. Mayo Clinic surgeons have experience performing awake brain surgery to remove brain tumors or epileptic foci that doctors previously considered inoperable. Mayo Clinic surgeons perform about 690 awake brain surgeries each year.
  • Team approach. At Mayo Clinic, brain surgeons (neurosurgeons) work with an integrated team of doctors trained in brain conditions (neurologists), anesthesia (anesthesiologists), speech and language (speech-language pathologists), and other areas to provide your care before, during and after awake brain surgery. Doctors also work with computer engineers, language interpreters and other specialists to care for people who may need awake brain surgery.
  • Technology. Mayo Clinic doctors use computer-assisted brain surgery and intraoperative MRI during awake brain surgery. Doctors may also conduct deep brain stimulation during awake brain surgery.
  • Research. Mayo Clinic doctors conduct research in several types of neurosurgery to treat neurological conditions, including awake brain surgery and other procedures.

Mayo Clinic in Rochester, Minn., ranks #1 for neurology and neurosurgery in the U.S. News & World Report Best Hospitals rankings. Mayo Clinic in Scottsdale, Ariz., is ranked among the Best Hospitals for neurology and neurosurgery, and Mayo Clinic in Jacksonville, Fla., is ranked high performing for neurology and neurosurgery by U.S. News & World Report. Mayo Clinic also ranks among the Best Children's Hospitals for neurology and neurosurgery.

At Mayo Clinic, we assemble a team of specialists who take the time to listen and thoroughly understand your health issues and concerns. We tailor the care you receive to your personal health care needs. You can trust our specialists to collaborate and offer you the best possible outcomes, safety and service.

Mayo Clinic is a not-for-profit medical institution that reinvests all earnings into improving medical practice, research and education. We're constantly involved in innovation and medical research, finding solutions to improve your care and quality of life. Your doctor or someone on your medical team is likely involved in research related to your condition.

Our patients tell us that the quality of their interactions, our attention to detail and the efficiency of their visits mean health care — and trusted answers — like they've never experienced.

Why Choose Mayo Clinic

What Sets Mayo Clinic Apart

Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people. In most cases, Mayo Clinic doesn't require a physician referral. Some insurers require referrals or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.

Doctors trained in neurosurgery, neurology, speech-language pathology, radiation oncology and other areas may be involved in treating adults who may need awake brain surgery at Mayo Clinic in Arizona. The integrated team in the Epilepsy Clinic cares for adults who have epilepsy.

For appointments or more information, call the Central Appointment Office at 800-446-2279 (toll-free) 8 a.m. to 5 p.m. Mountain Standard Time, Monday through Friday or complete an online appointment request form.

Doctors trained in neurosurgery, neuro-oncology, neurology, anesthesiology and other areas may be involved in treating adults who may need awake brain surgery at Mayo Clinic in Florida.

For appointments or more information, call the Central Appointment Office at 904-953-0853 8 a.m. to 5 p.m. Eastern time, Monday through Friday or complete an online appointment request form.

Doctors trained in neurosurgery, neurology, neuro-oncology, neuroanesthesiology, speech-language pathology, epilepsy and other areas may be involved in treating adults and children who may need awake brain surgery at Mayo Clinic in Minnesota.

For appointments or more information, call the Central Appointment Office at 507-538-3270 7 a.m. to 6 p.m. Central time, Monday through Friday or complete an online appointment request form.

Doctors trained in pediatric neurosurgery, pediatric neurology, pediatric anesthesiology and other areas may be involved in treating children who are candidates for awake brain surgery at Mayo Clinic in Minnesota.

For appointments or more information, call the Central Appointment Office at 507-538-3270 7 a.m. to 6 p.m. Central time, Monday through Friday or complete an online appointment request form.

See information on patient services at the three Mayo Clinic locations, including transportation options and lodging.

Mayo Clinic researchers study new imaging techniques and surgical techniques for awake brain surgery. Learn more about neurosurgery research.

Publications

See a list of publications by Mayo doctors on awake brain surgery on PubMed, a service of the National Library of Medicine.

Mar. 19, 2014