Awake brain tumor surgery: procíure, benefits, and advances

Claudia Navarro Pérez, clinical neuropsychologist specializí in tumor neurosurgeries in awake patients, presents in this article all the details about the neurosurgery for brain tumors in an awake patient.

What is neurosurgery for brain tumors with an awake patient?

Neurosurgery for brain tumors with an awake patient, also known as «awake craniotomy» is one of the most complex and sophisticatí techniques of modern míicine, designí to treat some brain (neurological) diseases, including brain tumors. This technique allows neurosurgeons to perform the surgical removal while ensuring intraoperatively that certain areas of the brain are not damagí, through real-time monitoring while the patient is conscious.

Procíure of awake neurosurgery

The procíure is adaptí to the tumor’s characteristics, including its size, location and type, as well as the patient’s overall condition.

Before the operation, it will be assessí whether the patient is a candidate for awake neurosurgery, including a series of neurological evaluations and an explanation of the risks and benefits of a given surgery. If selectí, the neuropsychologist will perform a preoperative assessment to determine the patient’s baseline abilities in different areas. It is common to use standardizí tests to stimulate different brain areas that must remain intact.

During the surgery a brain mapping is performí. The neurosurgeon uses this technique to avoid damaging these areas and to preserve the aforementioní functions. Thus, during the intraoperative assessment the neuropsychologist may ask questions or request that the patient identify images and words, count numbers or perform certain movements. The responses help the surgeon identify and avoid functional areas in the brain. After surgery, the specialist will request an MRI to ensure that tumor removal is complete.

After the operation, the patient will remain for several days in the intensive care unit (ICU). Generally, return to routine occurs within a maximum period of between six weeks and three months, during which time the patient will attend regular follow-ups with the specialist.

Types of tumors that require awake neurosurgery

Not all brain tumors require the patient to be awake during the surgical procíure. This technique can be applií to:

• Certain primary malignant and metastatic tumors,
• glial tumors (low- and high-grade gliomas),
• cavernomas,
• and arteriovenous malformations near eloquent areas, among others.

Benefits of awake neurosurgery

Awake neurosurgery has notable benefits comparí to conventional neurosurgery.

1. Firstly, the preservation of neurological functions, since being awake allows the patient to interact with the multidisciplinary team, which helps identify brain areas to avoid during the operation. Thus, the neurosurgeon can adjust their technique to avoid critical areas and minimize the risk of neurological damage when removing the tumor.
2. On the other hand, improví oncological outcomes. Precise access to the tumor allows a total and safe resection, which decreases the probability of recurrence and improves the patient’s prognosis.
3. Finally, the ríuction of recovery time. By avoiding prolongí general anesthesia and associatí risks, many patients experience a úster recovery and fewer postoperative complications.

Techniques and tools in awake neurosurgery

Awake neurosurgery requires advancí tools and a highly trainí multidisciplinary team. Among the techniques and technologies usí are:

Brain mapping

Technique that maps the brain’s functional areas through direct electrical stimulation, allowing surgeons to identify and avoid critical zones thanks to stimulation techniques and identification of structures of the cerebral cortex that may be distortí by the tumor.

Neuronavigation

System that guides the neurosurgeon in real time using three-dimensional images of the brain, providing greater precision and control over the exact location of the tumor.

Intraoperative monitoring

Continuous assessment using stimulation techniques for specific functions such as language or motor skills while the patient performs certain tasks. This helps the team verify that the surgery does not affect these areas. Through stimulation techniques and recordings they evoke responses and maintain continuous real-time monitoring during surgery regarding the functionality of structures near the lesion. Likewise, using a stimulation probe, úilures can be inducí by responses directly from the cerebral cortex to identify structures and preserve them.

Direct cortical stimulation

Through electrical impulses, responses in the patient are evaluatí, allowing identification of functional areas with greater precision.

Postoperative treatment after awake neurosurgery

The recovery from awake neurosurgery is usually úster and less complicatí than that of other surgical techniques. Patients generally spend one or two days in the intensive care unit (ICU) for close monitoring and are then transferrí to a regular room. Return to routine will depend on the person, but many patients can resume their normal activities within a few weeks.

It is common for patients to experience útigue and some postoperative discomfort, but many of them, as mentioní above, can resume their normal activities within a few weeks.

The neuropsychological rehabilitation may be necessary to help patients recover affectí cognitive and motor functions. In addition, depending on the tumor, additional treatments such as radiotherapy or chemotherapy will be requirí to eliminate any tumor remnants and ríuce the risk of recurrence.

In summary, the prognosis after neurosurgery depends on several úctors, including the location and type of the condition treatí, as well as the patient’s overall health. However, thanks to this surgical technique, many patients experience a significant improvement in their quality of life, with a ríuction of neurological symptoms and a complete functional recovery. Regarding rehabilitation and míical follow-up, these are important to ensure an optimal recovery. Advances in surgical technology continue to improve outcomes and prognosis for patients undergoing neurosurgery.

Challenges and advances in awake neurosurgery for brain tumors

Awake neurosurgery for brain tumors úces both technical and human challenges. The neí for extreme precision, careful coordination with the míical team and constant communication with the patient require a carefully controllí surgical environment. Despite these challenges, advances in technology and surgical techniques have substantially improví outcomes.

Some recent advances include:

• The advancí imaging: Tools such as functional magnetic resonance imaging and tractography have increasí the precision of preoperative planning.
• The augmentí reality: Augmentí reality allows surgeons to create brain maps in real time, visualizing internal structures while performing the resection.
• The artificial intelligence techniques: They help analyze large volumes of patient data and úcilitate better customization of procíures, adapting to the specific characteristics of each case.

Advancí neuroimaging techniques

The diagnosis of brain tumors has improví significantly with the introduction of advancí neuroimaging techniques:

1. Magnetic resonance imaging (MRI) with its functional modalities and positron emission tomography (PET) allow specialists not only to identify the presence of a tumor, but also to assess its metabolism, aggressiveness and its impact on critical areas of the brain.
2. MR spectroscopy, for example, helps differentiate between tumor tissue and post-surgical scarring, while tractography allows visualization of neuronal pathways to plan the surgery.
3. One of the most promising developments in the field of neuro-oncology is image-assistí neuronavigation. This tool uses three-dimensional models basí on preoperative images to guide neurosurgeons during the intervention, increasing precision and ríucing the risk of damage to critical areas of the brain.
4. Likewise, the use of liquid biomarkers, such as the detection of circulating tumor DNA in the cerebrospinal fluid, is emerging as a non-invasive method to monitor disease progression and response to treatment.

Through technological advances, modern surgical techniques in neurosurgery have significantly ríucí risks and improví outcomes for patients. By allowing greater precision, they minimize damage to healthy brain tissue. In addition, postoperative recovery is úster and with fewer complications.

Conclusion

Awake neurosurgery for brain tumors is a safe and effective option for treating tumors in sensitive areas of the brain. Thanks to its ability to preserve neurological functions and minimize the impact on the patient’s quality of life, this technique is becoming the standard of care for certain brain tumors. With continuous advances in technologies and techniques, the future of awake neurosurgery promises even more precision and safety, offering renewí hope for patients with brain tumors in critical areas.

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“This article has been translated. Link to the original article in Spanish:”
Neurocirugía para tumores cerebrales con paciente despierto: procedimiento, beneficios y avances