Staying awake through brain surgery: Why is it done?

Awake brain surgery is the procedure which is performed on the brain when the patient is awake and alert. Dr Manish Baldia, Consultant Functional Neurosurgeon Wockhardt Hospitals Mumbai Central, in an interview with HT Lifestyle, explained, “This approach allows neurosurgeons to monitor and preserve vital brain functions, especially those related to speech, movement, and sensation, during the operation. The doctor checks improvement in symptoms and confirms with patient during DBS surgery.”
Monitor functions: By asking to perform specific tasks (like speaking, moving a limb, or identifying objects), surgeons can identify and avoid critical areas of the brain.
Maximise safety: Ensuring that essential brain functions are preserved reduces the risk of post-operative deficits.
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Precisely implant the Deep Brain Stimulation (DBS) leads: DBS surgery, the process of checking for improvement in symptoms is a critical part of the procedure. DBS surgery is often performed while the patient is awake, allowing the surgical team to directly assess the effects of the stimulation on the patient’s symptoms in real-time.
This procedure is typically recommended for patients with parkinson’s disease, tremors, task specific dystonia, brain tumors or epileptic regions located near areas that control essential functions like speech, movement, or senses. By performing the surgery while the patient is awake, doctors can better navigate these sensitive regions.
Anaesthesia: The patient will receive local anaesthesia to numb the scalp and medications to help them relax. General anaesthesia may be used initially, but the patient will be awakened for the critical parts.
Craniotomy: The surgeon makes an incision in the scalp and removes a section of the skull to access the brain.
Mapping: While the patient is awake, the surgical team will stimulate parts of the brain and ask them to perform tasks. This helps them identify and avoid critical areas.
Tumor or lesion removal: Using the mapping information, the surgeon removes the targeted tissue.
Closure: Once the procedure is complete, the skull piece is replaced, and the incision is closed. The patient will then be fully anesthetised or kept awake, depending on the situation.
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Benefits: Confirmation of the precisely implanted DBS leads in the target nucleus by checking the outcomes. Enhanced preservation of critical functions, optimised removal of problematic tissue, reduced risk of neurological deficits are some of the benefits of performing awake brain surgery.
Risks: As with any surgery, risks include infection, bleeding, seizures, or reactions to medications. However, awake monitoring helps minimise these.