Our Summary

This study examines the use of awake craniotomy (a type of brain surgery where the patient is awake) in Japan. The researchers sent out a survey to 45 hospitals that perform this type of surgery, and 39 of them responded. They found that the majority of these hospitals (about 67% of them) perform less than 10 awake craniotomies a year, while the remaining 33% perform more than 10 a year. They also found that some hospitals had a high rate of adverse events, like seizures during surgery. In fact, about 28% of the hospitals reported that more than 10% of their awake craniotomies resulted in a seizure. Interestingly, they found that hospitals that perform a larger number of these surgeries (more than 10 a year) had fewer instances of seizures, despite the fact that the use of anti-seizure medication before surgery was similar in all hospitals. However, hospitals that perform fewer surgeries were more likely to use older types of anti-seizure medication. In summary, most hospitals in Japan perform less than 10 awake craniotomies a year, and those that perform more tend to have fewer complications like seizures.

FAQs

  1. How many hospitals in Japan perform awake craniotomies?
  2. Is there a correlation between the number of awake craniotomies a hospital performs and the rate of seizures during surgery?
  3. What type of anti-seizure medication is typically used during awake craniotomies?

Doctor’s Tip

A doctor may advise a patient undergoing a craniotomy to discuss the use of anti-seizure medication before surgery. It is important to follow the doctor’s recommendations and take the prescribed medication as directed to reduce the risk of seizures during the procedure. Additionally, patients should ask their healthcare provider about the experience of the hospital in performing awake craniotomies, as hospitals that perform a larger number of these surgeries may have lower rates of complications.

Suitable For

Patients who are typically recommended for craniotomy include those with brain tumors, epileptic seizures, vascular malformations, or traumatic brain injuries. Awake craniotomy may be recommended for patients who have tumors located close to critical brain regions that control speech, movement, or vision, as it allows the surgeon to monitor the patient’s neurological function during the procedure. Additionally, awake craniotomy may be recommended for patients who have a higher risk of post-operative complications, such as seizures, as it allows for real-time monitoring and intervention if necessary.

Timeline

Before craniotomy:

  • Patient is diagnosed with a brain tumor or other condition that requires surgical intervention
  • Patient undergoes preoperative testing and evaluation to determine if they are a candidate for surgery
  • Patient may meet with a neurosurgeon and anesthesiologist to discuss the procedure and potential risks
  • Patient may need to stop taking certain medications or make lifestyle changes in preparation for surgery

During craniotomy:

  • Patient is brought into the operating room and given anesthesia to induce sleep
  • Surgeon makes an incision in the scalp and removes a portion of the skull to access the brain
  • If the surgery is an awake craniotomy, the patient may be woken up during the procedure to ensure that critical brain functions are not affected
  • Surgeon removes the tumor or performs other necessary procedures
  • Skull is replaced and incision is closed

After craniotomy:

  • Patient is monitored closely in the recovery room for any complications
  • Patient may experience pain, swelling, and other side effects post-operatively
  • Patient may need to stay in the hospital for a few days or longer depending on the extent of the surgery
  • Patient may need physical therapy or other rehabilitation services to regain strength and function
  • Patient may need to follow up with their surgeon for further evaluation and monitoring of their condition.

What to Ask Your Doctor

  1. What is the reason for recommending a craniotomy in my case?
  2. What are the potential risks and complications associated with a craniotomy procedure?
  3. How many craniotomies does the hospital perform in a year? Is the surgical team experienced in performing this procedure?
  4. Will I be awake during the surgery? What are the benefits of an awake craniotomy?
  5. What type of anesthesia will be used during the procedure?
  6. What is the expected recovery time after a craniotomy? Will I need any rehabilitation or follow-up care?
  7. What are the success rates for this type of surgery in treating my condition?
  8. Are there any alternative treatment options to a craniotomy that I should consider?
  9. What is the hospital’s protocol for managing complications during and after the surgery, such as seizures?
  10. Are there any specific pre-operative instructions or preparations I need to follow before the surgery?

Reference

Authors: Kawata M, Fukui A, Mineharu Y, Kikuchi T, Yamao Y, Yamamoto Hattori E, Shiraki A, Mizota T, Furukawa K, Miyamoto S, Yonezawa A, Arakawa Y. Journal: Neurol Med Chir (Tokyo). 2022 Jun 15;62(6):278-285. doi: 10.2176/jns-nmc.2021-0290. Epub 2022 Mar 29. PMID: 35354712