'Awake Surgery' Gains Popularity

The thought of surgery is gruesome, but just imagine being awake while tangerine-sized flaps of your skull are cut open.

Awake surgery is becoming more and more popular with both surgeons and patients. It can be more precise and less damaging compared to traditional surgery, in which a patient is placed under anesthesia.

This type of surgery was first introduced decades ago for patients who suffered from epilepsy. Patients were kept awake and alert during surgery to ensure that the surgeons were removing the parts of brain that were causing seizures rather than the healthy parts.

Now, thanks to recent innovations, awake surgery is more frequently used to treat various forms of brain tumors. Brain-mapping technology and highly complex anesthetics have allowed specialists to feel comfortable keeping their patients awake during surgery. Specifically, brain-mapping technology creates a precise digital replica of the layout of a person’s brain. Due to such technologies, removing certain kinds of brain tumors while patients are fully sedated is not even considered an option anymore.

Recently, surgeons have used awake surgery to remove tumors that threaten the areas of the brain that control a person's movement, behavior, senses, memory, emotions, hearing, interpretation, balance, and coordination. While the patient is under anesthesia, the surgeon removes the tumor based on their patient’s ability to complete certain tasks, like answering basic math questions. By keeping the patient awake and asking them to complete such tasks, the surgeon can protect important areas of the brain while removing the threatening growth. Damage to any region of the brain can leave a patient vulnerable to loss of function.

Though it is called awake surgery, this treatment actually includes periods of being awake and asleep. After gathering data from the patient, the surgeon draws out a plan of where they are going to cut using the replica created by brain-mapping technology. Once it is time to operate, the patient receives a dose of propofol large enough to cause the patient to fall asleep so the growth can be removed. The process of gathering data while the patient is awake and then putting the patient to sleep to remove a growth may be repeated several times during one procedure to remove a growth completely.

New drugs and techniques are used to control the patient’s conscious and unconscious states. Patients can move between being awake and asleep in a matter of minutes, in fact. It is almost like flipping a light switch, said Dr. Robert Harbaugh, Director of the Neuroscience Institute at Penn State and President of the American Association of Neurological Surgeons. The technology has even created the option for one patient to play the violin while a surgeon operates to ensure that the patient's ability to play will not be affected.

One big concern many patients have about awake surgery is whether or not participating patients will feel anything. However, neurons in the brain do not have pain receptors, and if the scalp is properly numbed, patients will not feel anything the surgeon is doing.

Awake surgery has now gone beyond the brain. It is also used during surgeries involving the head, neck, and spinal cords. Similar to open brain surgery, spinal patients are asked to wiggle their toes to ensure the safety of critical motor nerves along the spine. Though the idea of awake surgery might scare some, evidence suggests it maybe helpful or even increasingly necessary in the future.

[Source: Time]