Our Summary

This research paper discusses awake craniotomy, a type of brain surgery where the patient is awake. This technique allows doctors to continuously monitor the patient’s clinical and neurological status during the surgery, helping them to detect early if there’s any damage to important areas of the brain. This way, doctors can remove as much of the problematic brain tissue as possible without affecting the patient’s neurological function.

To perform an awake craniotomy, doctors need to apply an effective local anesthetic to the scalp, monitor the patient during surgery, and have a well-coordinated surgical team. They can use a range of clinical and physiological techniques to assess the brain’s function during the operation.

In conclusion, awake craniotomy, with the use of scalp anesthesia, provides a valuable surgical option for lesions near critical areas of the brain. It allows doctors to assess the brain’s function during surgery, which is particularly important when operating close to these critical areas.

FAQs

  1. What is an awake craniotomy and how does it benefit the patient?
  2. What techniques are used to assess cortical function during an awake craniotomy?
  3. What is a scalp blockade and how is it used in an awake craniotomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about craniotomy is to stay calm and trust the medical team during the procedure. Being awake during a craniotomy can be intimidating, but it allows for better assessment of neurological function and can lead to better outcomes. Trusting in the expertise of the surgical team and following their instructions can help make the experience smoother and more successful.

Suitable For

Patients who are typically recommended for awake craniotomy include those with brain tumors located near eloquent cortex, such as language or motor areas, where preserving neurological function is a priority. Awake craniotomy may also be recommended for patients with epilepsy or vascular malformations to allow for intraoperative monitoring and mapping of brain function. Additionally, awake craniotomy may be recommended for patients who are at high risk for general anesthesia due to medical comorbidities.

Timeline

Before Craniotomy:

  • Patient undergoes preoperative evaluation and imaging studies to assess the location and size of the lesion in the brain.
  • Anesthesia team meets with the patient to discuss the awake craniotomy procedure and address any concerns or questions.
  • Scalp blockade is performed to provide local anesthesia to the surgical site.
  • Patient is positioned on the operating table and prepared for surgery.

During Craniotomy:

  • The surgeon performs a craniotomy, removing a portion of the skull to access the brain.
  • The patient is kept awake during the procedure to allow continuous assessment of neurological function and communication with the surgical team.
  • Various clinical and electrophysiological techniques are used to assess cortical function and ensure that eloquent areas of the brain are not compromised during resection.
  • The surgeon maximizes resection margins while preserving neurological function.

After Craniotomy:

  • The patient is closely monitored in the recovery room for any signs of complications or neurological deficits.
  • Pain management and wound care are provided to aid in the healing process.
  • Follow-up appointments are scheduled to monitor the patient’s recovery and assess the effectiveness of the surgery in treating the underlying condition.
  • Rehabilitation may be recommended to help the patient regain strength and function after surgery.

What to Ask Your Doctor

  1. What is the purpose of a craniotomy in my specific case?
  2. Why is an awake craniotomy being recommended for me?
  3. What are the potential risks and complications associated with a craniotomy procedure?
  4. How will my pain be managed during and after the procedure?
  5. How long will the recovery process take after a craniotomy?
  6. What kind of follow-up care will be needed after the craniotomy?
  7. How will my neurological function be monitored during the awake craniotomy?
  8. What kind of imaging or testing will be done before and after the craniotomy?
  9. How experienced is the surgical team in performing awake craniotomies?
  10. Are there any alternative treatment options to consider before proceeding with a craniotomy?

Reference

Authors: Hill CS, Severgnini F, McKintosh E. Journal: Acta Neurochir (Wien). 2017 Jan;159(1):173-176. doi: 10.1007/s00701-016-3021-z. Epub 2016 Nov 17. PMID: 27858231