How is awake brain tumor surgery performed?

In society, in the ranking of life-threatening diseases, oncological diseases come in second place after cardiac diseases. In oncological patients, brain tumors are the most common tumors seen after leukemias in the childhood age group and take part in high rank in the adult age group. As well as oncological results, it is important to preserve the characteristic functions such as speech, arm and leg movements, perception, hearing, vision after surgery in the treatment of brain tumors. In order to preserve these functions after surgery, there have been significant improvements in modern medical practice over the past 20 years.   Awake brain tumor surgeries are one of the topics that have become very popular in recent years. But it is not considered a method suitable for a brain tumor in every localization.  It is generally thought that it can be used more purposefully in tumors that have settled in the speech center.

What is awake brain tumor surgery?

Awake brain tumor surgery, as its name suggests, is a technique that the patient is awake during surgery and allows important functions such as speech, leg, and arm movements to be monitored during the operation, and thus aims to minimize the risks such as speech disorder and stroke after the operation. According to relevant function, this operation can be performed on brain tumors located in every area.

In which diseases is awake brain tumor surgery performed?

Currently, in modern neurosurgical practice, awake brain tumor surgery is a  technique used in the surgery of brain tumors located in the speech center of the brain. This is because the need to perform awake tumor surgery in the surgery of other regional tumors is not necessary, owing to current modern technologies. This is because neurological functions of this region can also be monitored while the patient is sleeping. However, since it is not possible to follow it during surgery under general anesthesia with current technologies, awake brain tumor operation should be performed if the tumor location is in speech center.

How is awake brain tumor surgery performed?

There are several types of performing world-class awake brain tumor surgery today. Brain area, that is brain's speech area of the patient called speech cortex, is mapped via a method called speech arrest during the surgery in awake brain tumor surgery that is performed in Turkey and is currently accepted in the world. The region that will not affect the speech or at least affect it is selected. During removal of the tumor, the patient's continuous speech functions are monitored throughout the operation. At the same time, addition to this technology, tumor tissue is distinguished from normal tissues by means of yellow-560 tumor staining, thus speech disorder after the surgery is reduced under 1%.

Frequently asked questions about awake brain tumor surgery

What are the advantages of awake brain tumor surgery?

Speech function cannot be monitored in any way while the patient is asleep. This is because speech center in the brain is also in communication with all other centers although it is located in 2 regions. Especially in speech center tumors, awake surgeries provide an important advantage.

Are skills such as playing instruments and painting used in awake brain tumor surgery?

Although it has been popular in the media recently that patients play various instruments during awake brain surgeries and perform actions related to their hand abilities, there is actually no validity to this. This is because the patient does not have to be awake during the operation in order to maintain his/her abilities such as playing piano and violin, painting. The most restrictive effect of awake brain surgeries is that the percentage of removal of the entire tumor is less than that the surgery that is performed while the patient is anesthetized. In case of loss of ability, tumors in the brain areas related to arm and leg movements of the patient can be removed more easily owing to a method called functional cortical mapping while the patient is anesthetized. In awake surgeries where such abilities are controlled, the possibility to undergo the 2nd surgery within the 1st week is 20% for the patient across the world. Therefore, as a method currently accepted in modern neurosurgery across the world, we prefer awake method is only preferred in case that the tumor is in speech center of the brain. Other abilities can be easily monitored while the patient is anesthetized.

What is the success rate of awake brain tumor surgery?

The success rate is divided into two in neurosurgical operations. It is safe awakening of the patient and percentage of removal of the tumor. The possibility of occurrence of speech disorder is under 1% in awake surgery that is performed in the patient who has tumor in his/her speech center. This success rate is 2-3% in surgeries performed with anesthesia. But success rate of removal of the tumor is not as high as in non-awake surgery. The success rate of tumor removal of roughly 80% and above is less than that of a patient who sleeps in awake surgery. If more than 20% of the tumor remains inside and if it is a malignant tumor, the 2nd operation must be recommended to the patient before starting radiation and chemotherapy. Therefore, awake surgeries that showed great promise in the world 15-20 years ago are not used today except for the tumors in the speech center. Main reason for this is that the tumor cannot be removed as much as desired. Patient of awake brain surgery should be selected very carefully.

Is pain felt during awake brain tumor surgery?

There is no pain fiber in the human brain. Therefore, pain is not felt when an operation is made in the brain. But human scalp, bone and cerebral cortex have pain fibers. For this reason, when an awake operation is to be performed, the patient is anesthesia at the beginning of the operation, and these areas are passed in a way that he/she does not feel pain, and the patient is awakened after cerebral cortex is opened. The patient does not feel any pain and suffering since there he/she does not feel pain in the operations performed inside the brain. After the operation is completed, the patient is anesthesia again during the closure phase.

Are the experiences of awake brain tumor surgery remembered after surgery?

Absolutely nothing is remembered owing to anesthesia technologies. The reason for this is that it is ultimately a traumatic situation although it is a different experience. It is ensured that it is forgotten so that there are no psychological effects in people.

Can a vein surgery, aneurysm surgery, or a vascular tangle surgery also be performed while the patient is awake?

Absolutely it is not performed. Awake surgeries can only be performed in the tumors that occur in the speech center of the brain.

How many hours does awake brain tumor surgery take?

Duration of awake surgery is no longer than non-awake surgery. They take approximately same duration. However, duration of brain surgeries is very changeable. It could take 4 hours, or it could take 15 hours. Theoretically, awake method is not preferred for the patients whose surgery will take more than 4 hours because the patient will get tired.

Which patients are suitable for awake brain tumor surgery?

There are tumor-related factors as well as patient-related factors in deciding on awake surgeries. If the patient's tumor is in the speech center, he/she is suitable for awake surgery; but if the patient has concomitant serious diseases such as heart, uncontrolled hypertension, uncontrolled diabetes, he/she is not suitable for awake surgery. Some patients absolutely do not want to undergo surgery awake. For those patients who are not suitable for this psychiatric condition, the choice of awake surgery is still not right. In addition, the patients who need to be operated in prone position are also not suitable for awake surgery.

What are the risks of awake brain tumor surgery?

There are 2 speech centers in the brain. One is related to the fluency of speech, and the second is the content of speech, that is the region is for understanding what you are talking about. One is located on the left frontal lobe, and the other one is located on the left temporal lobe. It is more correct to remove tumors in these areas according to the technique of awake brain surgery. However, awake surgery also has its own side effects. Its main limitation is that the percentage of removal of entire tumor is lower. Therefore, in modern neurosurgery, awake surgery is used only for speech center tumors. It is also not enough to prefer only awake vigilant method. Before starting the operation, speech center should be determined via a technology that is called speech arrest and in which speech center is mapped by stimulating the brain with electricity during the operation. The operation is planned and started as a result of discontinuation of speech with electrical stimulation, and completely mapping of speech center, and matching of these with the results taken under the control of navigation in MRI studies performed preoperatively. In addition, the risk of suffering an epilepsy attack during surgery is present in all awake brain surgeries. This risk may cause more serious consequences in awake brain tumor surgeries than in the surgeries in which the patient is anesthetized.

Prepared by the Medical Editorial Board. Our health library contents have been prepared for informational purposes only and with the scientific content on the registration date. For all your questions, concerns, diagnosis or treatment about your health, please consult your doctor or health institution.