Awake craniotomy for brain tumors: 8 questions

Imagine being able to talk to your doctors during brain tumor surgery without pain and give them immediate feedback while they operate. That’s exactly what happens during an awake craniotomy. A craniotomy is a type of surgery where a piece of the skull is temporarily removed to access the brain. In an awake craniotomy, the patient is woken up during surgery. MD Anderson doctors perform more than 90 awake craniotomies every year.   This highly specialized surgical procedure requires a team approach led by an experienced neurosurgeon and a neuroanesthesiologist. To learn more, we spoke to neurosurgeon Jeffrey Weinberg, M.D., and neuroanesthesiologist Shreyas Bhavsar, D.O. What’s the benefit of being awake during brain tumor surgery? Our 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. 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. Which patients are candidates for awake craniotomies? Awake craniotomies are frequently — but not...