Whether the patient will be able to remain calm during the procedure and respond to the neurosurgeon.

The patientвЂ™s general health (e.g., awake brain surgery is not performed in patients with some types of sleep apnea and those who are obese).

The importance of awake brain surgery in removing the tumor without damaging critical parts of the brain.

Together, they will decide if awake brain surgery is right for a particular patient, depending on: The neurosurgeon works very closely with the neuroanesthesiologist. The procedure is performed after the patientвЂ™s scalp is numbed and usually with the patient sedated. Awake brain surgery can shrink these tumors. Neurosurgeons perform awake brain surgery for tumors that have spread throughout the brain and do not have clear borders, such as some types of glioma.

Surgery would result in a significant loss of function.

They are too close to areas of the brain that control vision, language and body movements.

It enables the neurosurgeons to remove tumors that would otherwise be inoperable because: This procedure is called intraoperative brain mapping, or awake brain surgery. Neurosurgeons at the Johns Hopkins Comprehensive Brain Tumor Center perform many brain tumor procedures while the patient is awake but sedated. Once the tumor is removed, the neuroanesthesiologist will allow you to go back to sleep for the remainder of the procedure.What is intraoperative brain mapping ('awake brain surgery')? Throughout the surgery, the neuroanesthesiologist will be monitoring you, talking with you to keep you comfortable, and making sure you are not in pain. This brain mapping procedure continues as your tumor is removed, so your neurosurgeon knows exactly which regions of the brain to avoid. To do so, your neurophysiologist may ask you questions about how you are feeling, in addition to having you complete certain tasks like counting, reading, or naming objects in pictures. A neurophysiologist will be monitoring your reactions throughout the procedure, to help identify and protect important regions of the brain during surgery. Stimulation of the language regions of the brain will temporarily cause you to make errors or stop speaking. Stimulation of sensory regions of the brain will result in a tingly feeling on specific part of your body, like your face or feet. Electrical stimulation of the motor regions of the brain will cause specific muscles to contract, like in your leg or arm. Depending on the location of your tumor, you may experience different sensations. You will not feel pain during this stimulation.

Your neurosurgeon will begin stimulating different parts of your brain, by applying small electrical currents to the tissue around your tumor.

Once the brain is exposed, the neuroanesthesiologist will wake you up for the brain mapping procedure. While your neurosurgeon and neuroanesthesiologist will work together to determine what kind of anesthesia is best for you, typically patients are sedated during the beginning and end of the procedure, with local anesthesia throughout. This type of procedure is also done in cases of epilepsy, if the site where the seizures originate is near language, sensory, and motor regions of the brain. Read more about awake brain mapping (also called intraoperative mapping). Your scalp will be anesthetized, so you will not feel the operation or any pain. This allows the surgeons to remove as much of your tumor as possible, while preserving critical brain functions.ДЄwake brain surgery is possible because there are no pain receptors in the brain itself. Patients assist the process by answering questions (like counting or reading), to identify which parts of the brain are critical for functions like language or body movement. The technique is called awake brain mapping, which involves asking the patients to do various tasks while specific parts of the brain are stimulated. This allows the surgical team to precisely map out important areas of the brain to avoid during the surgery, in order to protect the patientвЂ™s language, sensory, and motor abilities.Д«efore the surgeons remove any brain tissue, the area surrounding the tumor is tested for its role in critical brain functions. Awake brain surgery (also called awake craniotomy) is done in cases when a tumor is close to regions of the brain that control language, cognition, sensation, and body movement.

Brain mapping procedure