Awake brain surgery in Arizona

Awake brain surgery offers significant advantages for patients, reducing the possibility of morbidity and increasing the likelihood of complete resection when surgery involves critical brain areas. Neurologic surgeons at Mayo Clinic in Phoenix/Scottsdale, Arizona, have experience performing this complex procedure for treating brain tumors and focal epilepsy, and soon will offer awake brain surgery for cavernomas and arteriovenous malformations.

"Neurological testing of patients during surgery adds a layer of safety," says Bernard R. Bendok, M.D., chair of Neurologic Surgery at Mayo Clinic's campus in Arizona. "We know right away if we are at risk of affecting speech or other critical functions, versus waiting until the patient wakes up."

Awake brain surgery requires close collaboration among neurologic surgeons, neurologists, neuroanesthesiologists and neuroradiologists as well as intraoperative monitoring technicians. Mayo Clinic's awake brain surgery protocol incorporates these services. "It takes all of them, working in tandem like an orchestra, to make awake brain surgery successful," Dr. Bendok says.

At Mayo Clinic, selected patients are offered the option of awake brain surgery or more-traditional procedures. Candidates for awake brain surgery must be cooperative and have sufficient cognition to communicate during the procedure. If patients become distressed during surgery, deeper sedation or general anesthesia remains an option.

"In my experience patients usually have no significant discomfort during the procedure," Dr. Bendok says. "If there is some memory of the awake portion, the patient remembers being comfortable. If done correctly, awake brain surgery is not an unpleasant experience."

Before surgery, functional is used to pinpoint critical areas of the patient's brain. Those pre-surgery images can be registered through an intraoperative image navigation system during the procedure, to guide the surgeon.

Scalp numbing is used to minimize or avoid incisional pain during and after surgery. During cranial incision and closing, the patient is under intravenous (IV) sedation. "During the 'awake' portion, the patient hovers between IV sedation and mild sedation," Dr. Bendok says.

Music chosen by the patient is played and neurological function is tested throughout the awake portion of surgery. "The patient is talking to a neurologist he or she has met before, so there is a rapport," Dr. Bendok says. "Someone is holding the patient's hand, which is very comforting."

Forgoing general anesthesia allows for neurological examination during and immediately after surgery. "The patients are able to talk to you right away and their recovery is more rapid, whereas with anesthesia, they're groggy for a couple of hours," Dr. Bendok says. Patients are often sent home the next day.

Minimally invasive techniques

Mayo Clinic also offers a range of minimally invasive brain surgeries, including:

  • Endoscopic treatment for skull base and brain tumors, aneurysms, and vascular malformations. Working with colleagues in Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic neurologic surgeons can approach these procedures through the ear bone or nose.
  • Laser surgery for focal, medication-resistant epilepsy.
  • Use of a catheter to aspirate a brain hemorrhage.
  • Use of a hand artery to more safely reach a brain aneurysm.

"At Mayo Clinic we like to consider every option for the patient and pick the one that best fits the patient's needs," Dr. Bendok says. "The goal is to reduce the risks of surgery and provide patients with faster recoveries and excellent long-term outcomes."