Awake brain surgery

During brain surgery a small part of the skull is removed to expose the brain. This can be done under general anaesthesia, but can also be performed under local anaesthesia. This is possible because the brain itself doesn't register pain. Awake brain surgery is also know as an awake craniotomy.

One of the problems when removing a brain tumor is that the different functionalities of the brain form a complex system and it's not always easy to differentiate them during surgery. On top of that can tumor tissue look very similar to the healthy tissue, despite good quality MRI-scans. For a neurosurgeon it's the goal of the surgery to remove as much tumor tissue as possible and to reduce the chances of the tumor growing back, but a few millimeters to far into healthy tissue can already cause a loss of function. Therefore some brain surgeries are performed with the person undergoing the surgery being awake.

Awake surgery

Before starting to remove tissue, it's important to know the location of the vital parts of the brain. To not cut in those parts and to not affect language, speech or motor skills, the brain will be stimulated with a small electrode. To precisely locate the functional areas of the brain that must be avoided, the neurosurgeon will ask the patient to perform small tasks such as talking, moving fingers, counting and looking at pictures.

If the patient is not responding to the electrical stimulation, that part of the brain has no function and can be removed. When the stimulation does have an effect, either stimulating or inhibit, the neurosurgeon will avoid these areas, while trying to take out as much of the tumor as possible. A response can be a movement or feeling, but can also mean someone stops speaking or moving. Due to awake surgery a neurosurgeon can prevent brain damage from removing the tumor. 

Within UNCH Haaglanden Medical Centre (HMC) is specialised in awake brain surgery. HMC is one of the five hospitals involved in the SAFE-Trial, a clinical research on the added benefit of awake brain surgery. 

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