Awake Craniotomy in Indore

What Is Awake Craniotomy?

Awake craniotomy is a specialised type of brain surgery in which the patient remains awake and responsive during part of the procedure. During this awake stage, the patient may be asked to speak, identify objects, count, move parts of the body, or answer questions. Also known as awake brain surgery, the procedure is used when the surgeon needs to operate close to eloquent brain areas responsible for important functions such as speech, movement, or language.

Why Is Awake Craniotomy Performed?

An awake craniotomy in Indore allows surgeons to monitor neurological functions while operating near critical areas of the brain. For example, a brain tumour may be located close to the speech area or motor cortex, where surgery could potentially affect language or movement. Keeping the patient awake during part of the procedure helps the surgical team assess these functions in real time and reduce the risk of neurological deficits.

Who May Be Considered for Awake Craniotomy?

Awake craniotomy may be appropriate if:

• The surgical aim is near important brain areas.

• Speech, language or movement needs to be monitored throughout the surgery.

• The patient can understand and obey orders during the surgery.

• The patient’s general medical and neurological condition allows for the procedure.

Brain Conditions Where Awake Craniotomy May Be Considered

• Selected Brain Tumours

Awake craniotomy is used for certain brain tumours located close to critical areas of the brain. The technique allows surgeons to monitor functions such as speech, language, and movement in real time while removing the tumour, helping them preserve these important functions as much as possible.

• Selected Epilepsy Surgery

In certain cases of epilepsy surgery, it may be essential to map functional areas in the brain and determine whether or not any tissue has to be removed which is responsible for seizure activity. The dedicated Apollo Neurosurgery team determines specific indications after conducting medical examinations.

Pre-Surgery Evaluation

Before the surgery, the neurosurgeons conduct various assessments to ascertain whether awake craniotomy surgery is suitable.

MRI and Brain Imaging

MRI and brain imaging tests help locate and measure the size of a tumour or other surgical target and correlate it with surrounding brain structures. 

Neurological Assessment

The neurological assessment, for example, can consist of testing:

• Hearing and speech

• Motor strength and motion

• Sensation

• Sight

• Coordination

• Memory & Cognition

Functional Mapping

Functional brain mapping is used to locate regions involved in brain functions such as movement and speech.

Anaesthesia and Sedation

Awake craniotomy does not necessarily mean that the patient will remain awake during the procedure. The doctor can decide to sedate or put the patient under anaesthesia during the early steps. When brain mapping or neurological tests are needed, the patient can be brought to an appropriate level of alertness. The anaesthesia team will monitor the patient's condition throughout the procedure.

How Is an Awake Craniotomy Performed?

The surgical process can usually be divided into the following steps: 

• Before surgery, the patient undergoes brain imaging, a neurological evaluation, and other necessary tests.
• Anaesthesia is administered to help the patient relax and remain comfortable during the procedure.
• The surgeon gives local anaesthesia to numb the scalp around the area where the skull will be opened.
• The surgeon opens the skull to access the brain.
• When neurological testing is required, the team reduces sedation so the patient can become awake and responsive.
• The surgical team assesses brain function, including speech, language, movement, and other activities.
• The surgeon removes the tumour or performs the planned procedure while continuously monitoring these functions.
• Once the procedure is complete, the surgeon replaces the skull bone and closes the incision with sutures.

Brain Mapping During Awake Craniotomy

Brain mapping is a vital part of numerous awake operations. Patients might be required to identify images, read text aloud, or answer questions. Their performance during these tasks provides valuable information about brain areas involved in language. 

The doctor may ask the patient to move their arm, hand, leg, or another body part during the examination. This allows doctors to study the correlation between the surgical area and the motor cortex. Other functions might also be evaluated. Mapping techniques differ depending on the patient's condition and the operation.

What Does the Patient Experience During Surgery?

Patients are awake only when the surgical team needs to interact with them or assess specific brain functions. For the rest of the procedure, they may be asleep or lightly sedated and kept comfortable. The surgical team injects local anaesthetic into the scalp to numb the surgical area. Throughout the procedure, the anaesthetist and surgical team closely monitor the patient and adjust sedation or administer medication as needed.

Benefits and Limitations

One of the advantages of awake craniotomy is that it gives the surgical team access to neurons and part of the brain during surgery. Awake craniotomy provides real-time information about speech and movement, but it has limitations. 

Not all brain tumours need to be treated with this method, and the functional localisation technique does not eliminate all the risks of brain surgery.

Risks and Possible Complications

Awake craniotomy has many risks. These include:

• Bleeding

• Infection

• Swelling of the brain

• Seizure episodes

• Stroke

• Speech or language problems

• Weakness or difficulty in movement

• Vision changes

• Trouble with coordination or balance

• Leakage of cerebrospinal fluid 

Recovery After Awake Craniotomy

Recovery differs for each patient. After surgery, physicians monitor neurological status, the surgical site, and the overall recovery process. Patients may need regular post-surgery neurological examinations to assess speech, movement, strength, and other functions. Some patients may need access to rehabilitation programs and additional treatment.

Neurosurgical Care at Apollo Hospitals Indore

Apollo Hospitals Indore offers seamless awake brain surgery in Indore under the supervision of highly experienced surgeons, backed by cutting-edge equipment and world-class facilities. Awake craniotomy for brain tumour allows the doctors to monitor functional brain segments during tumour removal, as well as discuss neuro-navigation and neurocritical care services. 

FAQs

1. What is awake craniotomy?

Awake craniotomy is a surgery performed on the brain where the patient is awake for certain parts of the surgery for the surgical team to evaluate vital neurological functions. 

2. Why is awake craniotomy performed?

An awake craniotomy is performed when the surgery is conducted in and around an area of the brain that is responsible for vital functions like speech, movement, etc. 

3. Is the patient completely awake during brain surgery?

Patients may not be awake for the entire awake neurosurgery procedure, but they may be awake for procedures that require neurological testing. 

4. Is awake craniotomy painful?

Local anaesthesia is used to numb the scalp for brain tumour surgery in Indore, while medications can also be utilised to ensure comfort and relaxation. Nonetheless, the patient will experience pressure, among other sensations. 

5. Who may be a candidate for awake craniotomy?

Designated surgical patients need to undergo certain evaluations to determine eligibility.