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Awake Craniotomy and Brain Mapping

Washington University neurosurgeons at Barnes-Jewish Hospital use sophisticated techniques for brain mapping to advance awake craniotomy procedures – the gold standard of surgery to treat certain dangerous brain tumors. Approximately 15 patients a year undergo this surgery at Barnes-Jewish, and these brain mapping techniques – including techniques developed at Washington University – coupled with intraoperative MRI technology, can give patients better outcomes and preserve more healthy brain tissue.

Awake Craniotomy Procedure

In an awake craniotomy surgery, the patient is sedated while the surgeon opens the skull to expose the brain. The patient is then brought out of sedation to full consciousness. The patient can interact with the doctor during the procedure. This interaction is the most reliable way to ensure that the doctor does not damage healthy tissue while removing as much of the tumor as possible. The doctor will ask the patient to answer questions and perform simple tasks, to make sure their motor and speech function remains intact.

During the surgery, the patient will feel no pain, as the brain itself does not have pain receptors.

Awake craniotomies are performed in the intraoperative MRI suite that allows neurosurgeons to make real-time MRI images during the procedure. This lets surgeons get a high resolution picture of the brain as another way to insure that the maximum amount of tumor is safely removed.

In addition, doctors at Washington University and Barnes-Jewish use several techniques to map the brain before and during the surgery. These techniques help neurosurgeons pinpoint areas of the brain that control different behaviors. These techniques include using a grid of sensors laid directly on the surface of the brain to detect electrical signals. A computer program collects the electrical data and generates a digital map to guide the surgeons to the tumor tissue with greater accuracy.

Using brain mapping with awake craniotomy, “we are able to accomplish a more aggressive surgery in sensitive areas while preserving function,” says Eric Leuthardt, MD, Washington University neurosurgeon at Barnes-Jewish. Dr. Leuthardt is nationally known for advancing brain mapping techniques.

What to Expect

For patients with difficult brain tumors in areas near speech or motor centers in the brain, awake craniotomy offers better outcomes and preserves more functionality than many other treatments. These patients may have a shorter recovery time in the hospital.

For a referral to a Washington University neurologist or neurosurgeon at Barnes-Jewish Hospital, call 855.925.0631.

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