What is awake brain surgery? Awake brain surgery is an advanced procedure in which the patient remains awake during parts of the procedure so that the surgeon can accurately assess brain functions. This technique is usually used when a lesion such as a brain tumor or an epileptic focus is located near the sensitive areas of the brain. Unlike traditional surgeries where the patient is under complete anesthesia, in this method only the scalp and skull are numbed, because the brain itself does not have pain receptors, which makes it possible to preserve the vital functions of the brain during the operation and increase the precision of the surgery. ### What is the reason for brain surgery while awake? **Awake brain surgery** is performed for several key reasons:
1. Maintaining vital functions such as the ability to speak, move, or memory. 2. Reducing the risk of neurological complications after surgery; Example: Preventing damage to the speech area if a tumor is located near it. 3. Live interaction with the patient during surgery and the use of brain mapping techniques to increase the accuracy of the operation. 4. Special importance in cases where the lesion is located in the functional areas of the brain. ### What is the difference between awake brain surgery and traditional surgery? The main difference between awake brain surgery and **open brain surgery** is the patient's consciousness and live interaction with the surgeon. In the awake method, the patient performs tasks such as talking or moving the hands so that sensitive areas of the brain can be identified more precisely, while in traditional surgery the patient is completely unconscious and the surgeon operates only with his images and experience. This method increases the accuracy of the operation and reduces the risk of nerve damage. **What diseases are treated with brain surgery while awake?**
This method is used to treat diseases that are related to the sensitive areas of the brain. Common diseases include the following:
- Brain tumors, such as low-grade gliomas or meningiomas close to functional areas. - Treatment-resistant epilepsy, especially when the focus of epilepsy is in sensitive areas such as the temporal lobe. - Movement disorders such as Parkinson's or dystonia, especially in deep brain stimulation surgeries. According to studies, about 20 percent of brain surgeries for tumors near sensitive areas use this method to reduce the risk of neurological defects. This technique has shown positive results especially in cases where the lesion is close to speech or memory centers. **Which parts of the brain are operated while awake?**
The human brain is made up of different parts, each of which has a specific role in daily functions. In awake brain surgery, surgeons typically focus on the following areas:
1. Frontal lobe: responsible for thinking, planning and voluntary movements. 2. Temporal lobe: related to memory, hearing and understanding language. 3. Broca's area: the main center of speech production. 4. Wernicke's area: responsible for understanding language. 5. Motor cortex: control of body movements. Surgeons identify these areas during surgery using direct electrical stimulation. For example, the patient may repeat words or move his hand during surgery so that the surgeon can make sure that these areas are working properly. This process helps the surgeon create a precise map of the patient's brain. **What are the advantages and disadvantages of brain surgery while awake?**
Advantages and disadvantages of awake brain surgery include the following:
Benefits of awake brain surgery:
- High accuracy of surgery and increasing the probability of complete removal of the lesion
- Reducing the risk of neurological defects by 30%
- Improving the quality of life and better performance of speech and movement after the operation
Disadvantages of awake brain surgery:
- Mental stress caused by being awake during the operation
- Technical complexity and the need for a highly skilled surgical team
- Longer duration of surgery compared to traditional methods
- However, due to the local anesthesia, the pain is usually tolerable
In 2021, a study of 469 patients who underwent awake craniotomy showed that only 1.7% experienced permanent side effects. In another study, 88% of glioblastoma patients who underwent this type of surgery succeeded in completing the brain mapping process. Medical News Today
What preparations are necessary for brain surgery in consciousness? Preparation for this surgery includes several steps that go beyond the usual surgical preparations. Patients must be mentally prepared to remain alert in the operating room, which includes counseling sessions with a psychologist to reduce anxiety. Imaging tests such as functional MRI and CT scan are done to map the brain precisely. In addition, neurological tests to assess preoperative speech, memory, and movement are necessary to provide a benchmark for comparison during surgery. Patients should avoid taking medications such as nonsteroidal anti-inflammatory drugs that increase the risk of bleeding for several weeks before surgery. A balanced diet, adequate sleep and stress reduction are also key recommendations before surgery. **What is the process of performing brain surgery while awake?**
This surgery includes specific steps that are performed with careful coordination between the surgical team. In the table below, the main steps of this process are summarized:
During the procedure, the patient may be asked to repeat sentences, name objects or even sing to check the function of the speech areas. This live interaction maximizes surgical precision. What types of tumors can be operated on while awake?
This method is especially suitable for tumors that are located near sensitive areas of the brain such as speech, movement or memory centers. Among the common tumors that can be treated with brain surgery while awake, the following can be mentioned:
Is awake brain surgery suitable for all patients? This method is not suitable for all patients and patient selection depends on several factors. Patients with the following conditions may not be suitable candidates:
- Old age or poor physical health. - Severe anxiety or inability to cooperate during the procedure. - Lesions located in non-sensitive areas of the brain. Younger patients with good general health and the ability to cooperate during the operation are the best candidates. The doctor makes the final decision by evaluating the patient's condition, the location of the lesion and the results of the pre-operative tests. *]:pointer-events-auto scroll-mt-(--header-height)" dir="auto" tabindex="-1">
What is the cost and price of awake brain surgery?
The cost of awake brain surgery in Iran depends on many factors, including the type of tumor (benign or malignant), its location in the brain, hospital or the chosen clinic, the experience of the surgeon, the type of insurance and its coverage, and the need for specialized equipment such as brain mapping systems.
1. **Type of tumor**: Malignant or more complex tumors require more specialized surgeries, which increase the cost. 2. **Equipment used**: The use of brain mapping systems and advanced equipment can increase costs. 3. **Insurance**: Insurance coverage can cover a significant part of the costs, but the amount of coverage depends on the type of insurance and its contract with the hospital. **What is the patients' experience of brain surgery while awake?**
Patients' experience of this surgery is often a combination of surprise and reassurance. Many report that they feel no pain due to local anesthesia, but being conscious in the operating room is an unusual experience. > One of the patients stated in a research: "When they asked me to say the names of objects, I felt part of the treatment process."
Studies show that more than 85% of patients are satisfied with the results of this surgery and believe that their quality of life has improved. However, some patients may need postoperative psychological support due to psychological stress. This experience, although challenging, is worthwhile for many because of the positive results and high accuracy. **Conclusion: Why is brain surgery in the waking state of the future of neurology?**
Awake brain surgery is not only an innovative surgical technique, but also an effective step towards improving the safety, accuracy and quality of life of patients. > According to studies published in *Journal of Neurosurgery*, the incidence rate of permanent neurological complications in this method is less than 4%, while in traditional surgeries it may reach more than 15%. Also, the percentage of complete removal of low-grade tumors in these patients has increased up to 90%, without disrupting vital brain functions. source
