So, YEahh, It is possible…
See with your Eyes >>>>>>>Awake Craniatomy <<<<<<<<
Awake craniotomy is mainly used for mapping and resection of lesions in vitally important brain areas where imaging is not sufficiently sensitive. These are most commonly speech and motor areas. The awake approach has become increasingly popular with wider indications due to the advantage of better neurological and other perioperative outcomes including analgesia and postoperative nausea and vomiting. (Anesthesiology, 2018).
I divided this topic in:
• What’s Awake Craniatomy ?
• Which patients are candidates for awake craniotomies?
• How is it possible to wake up during brain surgery without feeling pain?
• What happens while I’m awake?
The name this surgery is Craniatomy and in an awake craniotomy, the patient is woken up during surgery.
The goal is to remove as much of the tumor as possible, as safely as possible. When a tumor is near an area of the brain that controls critical functions, such as speech, language or movement, an awake craniotomy is the best way to identify and safely preserve those abilities.
But, before , Let’s take a look in the “What would be a craniotomy”.
A craniotomy is the surgical removal of part of the bone from the skull to expose the brain. Specialized tools are used to remove the section of bone called The bone flap.
The bone flap is temporarily removed, then replaced after the brain surgery has been done.
Craniotomies vary in size and complexity. Small dime-sized craniotomies are called “burr holes” and "keyhole" craniotomies are quarter-sized or larger. They are used for minimally invasive procedures (Spine, 2022).
Some craniotomy procedures may use the guidance of computers and imaging (magnetic resonance imaging [MRI] or computerized tomography [CT] scans) to reach the precise location within the brain that is to be treated. When either of these imaging procedures is used along with the craniotomy procedure, it is called Stereotactic craniotomy.
But i’m sure that you didn’t understand anything ...
So...
I will leave this technical parts for later and we begin now with ”how it works the awake Craniatomy”
We know where certain functions are generally located on the brain’s surface. But below the surface, bundles of nerves pass through the brain to the spinal cord and throughout the body. We have to map these nerves to understand which ones are connected to key functions, so that we can avoid them as we remove the tumor. Damaging critical nerves could cause permanent disability.
We also use other tools to map brain function, but mapping nerves during an awake craniotomy is the only way to obtain immediate feedback during surgery.
Awake craniotomies are frequently, but not always, used for gliomas (including glioblastoma, astrocytomas and oligodendrogliomas). These brain tumors tend to occur in the frontal and temporal lobes, which control speech and motor function. The patient also has to feel comfortable with the idea of waking up during surgery. A patient with severe symptoms may not be able to effectively contribute to the neurological exams during surgery.
Brain tissue doesn’t have any pain fibers, so while you may feel pressure or vibrations from
the surgery, you shouldn’t feel pain.
We use a local anesthetic (similar to those used at a dentist’s office) to numb the muscles, skin and bone that the surgeon has to cut through to get to the brain.
When you wake up, you’ll hear the neuroanesthesiologist reassuring you. You won’t be able to move your head, but the neuroanesthesiology team will make you as comfortable as possible and stay with you the entire time.
You could be awake for 45 minutes to several hours, depending on how big your tumor is, where it’s located and the type of symptoms you had before surgery.
While you’re awake, you’ll be an essential participant in the most critical part of the surgery.
You’ll help map your own brain function through a series of simple neurological exams.
The neurosurgeon will stimulate part of your brain near the tumor by sending a light electrical current down the nerves. At the same time, the neuroanesthesiologist will give you some simple verbal tasks to see if the stimulation affected your neurological function.
For example, you may be shown flashcards with common objects. If you suddenly can’t name an object or can’t get any words out at all, the neurosurgeon will know the area they’ve stimulated is connected to a critical speech area.
Even when you’re not actively mapping, you’ll talk to the neuroanesthesiologist and neurosurgeon, who are in constant communication throughout the surgery. This is important for ensuring a safer surgery, with the best possible outcomes.
So…
Backing to technical parts about brain surgery ...
A stereotactic brain surgery is a surgical procedure where lesion, frequently is a brain tumor, that image taken on MRI or CT are imported into the computer system that provides us with a 3-dimensional image of your brain and we get intended target while the MD are in the operating room.
They use this image, along with instruments that show us exactly where we are in the brain as we work to guide our removal of the target lesion.
The biggest risk is bleeding in the tumor and brain from the surgery. Bleeding can cause anything from a mild headache up to a stroke, coma, or even death. The risk of bleeding following surgery is around 5% and the risk of mortality is around 1%. Additional risks can include headache from the surgical site, infection, and seizures. Additional risks can be posed by the anesthesia itself (Rochester, 2022).
There are other kind of stereotactic surgery as :
· Stereotactic biopsy of the brain (a needle is guided into an abnormal area so that a piece of tissue may be removed for exam under a microscope).
· Stereotactic aspiration (removal of fluid from abscesses, hematomas, or cysts).
· Stereotactic radiosurgery (such as gamma knife radiosurgery).
· An endoscopic craniotomy is another type of craniotomy that involves the insertion of a lighted scope with a camera into the brain through a small incision in the skull.
Aneurysm clipping is another surgical procedure which may require a craniotomy. A cerebral aneurysm (also called an intracranial aneurysm or brain aneurysm) is a bulging weakened area in the wall of an artery in the brain, resulting in an abnormal widening or ballooning. Because of the weakened area in the artery wall, there is a risk for rupture (bursting) of the aneurysm. Placement of a metal clip across the "neck" of the aneurysm isolates it from the rest of the circulatory system by blocking blood flow, thereby preventing rupture (Medicine, 2022).
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Here's a video of one Awake Craniatomy
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References:
References
Anesthesiology, C. J. (2018, June). Columbia. Retrieved from https://journals.lww.com/rca/fulltext/2018/06002/awake_craniotomy__indications,_benefits,_and.9.aspx
Medicine, J. H. (2022). Retrieved from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/craniotomy
Nunez, K. (2020, September 14). HealthLine. Retrieved from https://www.healthline.com/health/craniotomy
Rochester, U. o. (2022). Retrieved from https://www.urmc.rochester.edu/neurosurgery/services/treatments/stereotactic-brain-surgery.aspx#:~:text=A%20stereotactic%20brain%20surgery%20is,through%20the%20brain%20and%20safe
Spine, M. B. (2022). Retrieved from https://mayfieldclinic.com/pe-craniotomy.htm
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