Our Summary

This research paper discusses Awake Craniotomy (AC), a procedure that’s becoming more common for brain tumor surgery. This type of surgery is done when the patient is awake, which allows the surgeons to better preserve the functioning parts of the brain and remove more of the tumor. However, there’s a risk that the patient might experience seizures during the operation. These seizures could disrupt the process of mapping and monitoring the patient’s brain activity during the surgery and might even cause the surgeons to stop the awake procedure.

FAQs

  1. What is an awake craniotomy and why is it becoming popular for brain tumour surgery?
  2. What are the advantages of awake craniotomy in terms of preserving the eloquent cortex and tumour resection?
  3. What potential problems can occur during an awake craniotomy, such as intraoperative seizures?

Doctor’s Tip

One helpful tip a doctor might tell a patient about craniotomy is to follow all pre-operative instructions carefully, including fasting guidelines and medication instructions. It is important to communicate any concerns or questions with your healthcare team before the procedure to ensure a smooth and successful surgery. Additionally, following post-operative care instructions, such as medication schedules and activity restrictions, will help promote healing and reduce the risk of complications.

Suitable For

Patients who are typically recommended for craniotomy include those with brain tumors, epilepsy, traumatic brain injuries, arteriovenous malformations, aneurysms, and other conditions that require surgical intervention in the brain. Awake craniotomy may be recommended for patients with tumors located in or near eloquent areas of the brain, where preserving brain function is crucial. This procedure allows for real-time mapping and monitoring of brain function during surgery, leading to better outcomes and potentially greater tumor resection. However, patients with a history of seizures or other neurological conditions may be at higher risk for intraoperative seizures during awake craniotomy, which can complicate the procedure and may require adjustments in the surgical approach.

Timeline

Before craniotomy:

  1. Patient undergoes pre-operative evaluation and imaging studies to determine the location and size of the brain tumour.
  2. Patient meets with neurosurgeon and anesthesiologist to discuss the procedure, risks, and benefits.
  3. Patient may undergo a pre-operative shave and skin preparation for the surgery.
  4. On the day of surgery, patient is admitted to the hospital and prepared for the procedure.

During craniotomy:

  1. Patient is given anesthesia and the head is secured in a fixed position.
  2. Surgeon makes an incision in the scalp and removes a portion of the skull to access the brain.
  3. In an awake craniotomy, patient is woken up during the surgery to help map and monitor brain function while the tumour is removed.
  4. Intraoperative monitoring and imaging are used to guide the surgeon in removing the tumour while preserving important brain functions.
  5. Once the tumour is removed, the skull is replaced and the incision is closed.

After craniotomy:

  1. Patient is monitored closely in the recovery room for any signs of complications.
  2. Patient may experience headaches, nausea, and dizziness in the immediate post-operative period.
  3. Patient may stay in the hospital for a few days for observation and pain management.
  4. Patient may require physical therapy and rehabilitation to regain strength and function.
  5. Follow-up appointments with the neurosurgeon are scheduled to monitor recovery and discuss further treatment options.

What to Ask Your Doctor

  1. What are the risks and benefits of undergoing a craniotomy procedure?
  2. How will I be monitored during the surgery?
  3. What is the likelihood of experiencing intraoperative seizures during the procedure?
  4. How will intraoperative seizures be managed if they occur?
  5. How will my pain be managed after the surgery?
  6. What is the expected recovery time and rehabilitation process after a craniotomy?
  7. Are there any long-term effects or complications associated with a craniotomy?
  8. What is the success rate of the procedure in terms of tumor resection and preservation of brain function?
  9. Are there any alternative treatment options available for my condition?
  10. How can I prepare for the surgery and what can I expect during the recovery period?

Reference

Authors: Khalil M, Shah Z, Saeed Baqai MW, Shamim MS. Journal: J Pak Med Assoc. 2022 Sep;72(9):1878-1879. doi: 10.47391/JPMA.22-95. PMID: 36281000