Awake Craniotomy and Brain Mapping for Tumors

Brain tumors may form in parts of the brain that control crucial functions like movement, speech, and vision.

With awake craniotomy and brain mapping, UPMC neurosurgeons can help protect these functions. This advanced technology allows them to map brain function before they safely remove brain tumors.

What Is An Awake Craniotomy and Brain Mapping?

It's a type of brain surgery to remove tumors while you're awake.

During an awake craniotomy, UPMC neurosurgeons remove a small piece of your skull to make an opening.

They use this opening to access and remove brain tumors. They can also repair any damage to nearby brain tissue.

Neurosurgeons may do awake brain surgery when tumors are in parts of the brain that control functions like:

Movement.
Speech.
Vision.

Your neurosurgeon will talk with you in order to map brain function.

They may ask you to respond to certain questions or commands. Your responses help guide your surgeon to remove the brain tumor and preserve vital brain functions.

Is Awake Brain Surgery Right for Me?

Awake craniotomy isn't right for everyone.

Generally, neurosurgeons use awake brain surgery if you have a complex brain tumor.

A complex brain tumor may:

Become involved with or attached to the brain's blood vessels.
Form in areas that control speech and movement (frontal, parietal, temporal, and occipital lobes).

Your UPMC neurosurgeon will ask you about any symptoms you have to see if this surgery is right for you.

They'll also take into account:

Your age.
Your concerns and feelings about awake brain surgery.
Your health and any other conditions you may have (like obesity, sleep apnea, or trouble breathing).
The type of brain tumor you have and how it's growing (its grade).
If you'll be able to respond to the their questions and commands.

What Are the Risks and Benefits of Awake Brain Surgery?

Awake craniotomy offers many benefits in treating brain tumors.

Your neurosurgeon interacts with you during the procedure to get real-time feedback. This helps protect your vital brain functions as they remove the brain tumor.

Awake brain surgery may also help you:

Spend less time in the ICU post-op.
Have a shorter hospital stay.
Avoid general anesthesia risks and side effects like nausea and throwing up.

But awake craniotomy also poses some risks, such as:

Seizures during surgery.
Brain swelling.
Changes in your coordination and balance.
Memory loss.
Vision changes.

What Happens During Awake Brain Surgery?

During awake craniotomy, surgeons use advanced brain mapping technology. This helps them find the precise areas of your brain that control movement and speech that they'll avoid during surgery.

They keep you awake during surgery so they can constantly monitor and protect your brain function. They do this while removing as much of the tumor as possible.

Before awake craniotomy

You may have questions about how to prepare for awake brain surgery.

Before surgery, your UPMC neurosurgeon will:

Talk with you to make sure you're comfortable with the procedure.
Give you details about the brain mapping process so you'll know what to expect.
Answer any questions you have.
Ask you to take simple tests, such as naming words or pictures. They may do the same tests during surgery to compare your answers and check your brain function.
Take pictures of your brain to compare them to the ones we take during surgery.

Your surgeon and anesthesiology expert will also talk with you about the type of anesthesia you'll have.

They may give you:

A shot in the scalp area (local anesthesia) so you stay awake for the entire surgery.
Local anesthesia in the scalp area and a small amount of medicine to make you sleepy at first. When your neurosurgeon is ready to remove the tumor, they'll wake you so they can talk with you. You won't feel any pain when you wake up. They'll give you more medicine so you're asleep when the surgeon removes the tumor.

During awake craniotomy

When surgery begins, your neurosurgeon will use a small device called an electrode to stimulate areas of your brain. This helps them precisely locate areas that control your speech and movement.

They may also:

Ask you questions.
Have you raise a hand or finger.
Ask you to tell them what's in a picture they show you.

Specialists will take more scans of your brain.

They compare these images to the ones they took before surgery. They'll also them along with your responses to map your brain's critical areas.

When brain mapping is complete, your neurosurgeon will use this data to:

Remove as much of the brain tumor as they can.
Avoid brain tissue that helps you talk and move.

Is awake craniotomy painful?

No. Throughout surgery, your anesthesiologist continuously checks to make sure you don't feel any pain. They also check your blood pressure and heart rate.

Your doctors talk with you to make sure you're not feeling anxious.

After awake craniotomy

When your neurosurgeon has removed the tumor, they:

Reattach the piece of bone to your skull to close the opening.
May insert a thin metal plate to strengthen the area.
Stitch up the skin on your scalp.

You'll stay in recovery while the anesthesia wears off. You may move to the ICU or a neurologic care unit for a short time while you heal.

Neurorehab experts may visit to see if you can benefit from:

Occupational therapy.
Physical therapy.
Speech and swallowing therapy.

If you're doing well, you can leave the hospital in a day or two.

Awake Craniotomy Recovery

Healing after awake brain surgery takes time. The incision in your scalp may become sore.

You may also have:

Swelling in your scalp or around your eyes.
Bruising around your eyes.
Numbness and pain near the incision.
An itchy scalp as the incision heals.

As you heal, be sure to follow your UPMC neurosurgeons instructions. You'll need extra rest.

Your doctor will tell how long before you can:

Drive.
Exercise or play sports.
Travel.
Go back to work or school.
Drink alcohol.

You may have some side effects after the surgery. Talk to your doctor about what's normal.

Let them know right away if you have:

Redness or warmth at the incision site.
Swelling in your neck, groin, or armpits.
Fever.
Headaches.
Excessive sleepiness.
Nausea and vomiting.
Vision changes.
Confusion or fainting.

Trust UPMC With Your Awake Craniotomy

UPMC neurosurgeons are experts in performing awake craniotomy for brain tumors.

We let you know what to expect throughout the entire awake brain surgery and mapping process. And we'll make sure you have all the details you need to decide if it's right for you.

Contact the UPMC neurosurgery team to learn more about awake craniotomy or make an appointment.

Contact the UPMC Department of Neurosurgery

To make an appointment or learn more:

Call us at 1-412-647-3685 or outside the U.S., call 1-877-320-8762.
Fill out our UPMC Neurosurgery contact form.