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Awake Brain Surgery Explained by Leading Neurosurgeon - Dr. Archil Eristavi

In the article below, a leading neurosurgeon in Tbilisi, Georgia Dr. Archil Eristavi shares detailed information about awake brain surgery - when and how it is used, what is the procedure and what are the benefits of this type of brain surgery. 


awake brain surgery, awake craniotomy, leading neurosurgeon in Tbilisi, Georgia

What is awake brain surgery, and when is it used?


Awake brain surgery, or awake craniotomy, is a surgical procedure performed on the patients while they are awake and conscious. We use this technique when dealing with brain tumors, vascular pathologies (e.g. arteriovenous malformation), or epileptic seizures to map and monitor brain function in real-time during the surgery. The primary goal is to maximize the effectiveness of the procedure while preserving critical brain functions.


What is the process of awake brain surgery?


The process involves several key steps:


1. Anesthesia: We start by administering a local anesthetic to numb the scalp. This keeps the patient comfortable and pain-free during the procedure. There are two ways of doing awake brain surgery. One is when the patients remain awake during the whole procedure (awake craniotomy), and in the a second way (asleep-awake-asleep) the patients are woken up only for when the neurosurgeon is approaching and manipulating close to the eloquent cortex of the brain e.g. primary motor and  somatosensory cortex (precentral and postcentral gyrus), or speech area AKA Broca’s area (posterior inferior frontal gyrus on the dominant hemisphere) and language area AKA Wernicke's area ( the posterior segment of the superior temporal gyrus in the dominant hemisphere).


2. Brain Mapping: After the craniotomy is done, we start brain mapping to identify and protect essential brain functions. We often use electrical probes to stimulate the areas around the pathological lesion in the brain. The patient may be asked to perform tasks or answer questions while we stimulate these regions.


3. Tumor or other pathological lesion removal: once we've mapped the areas of the critical function in the brain, we proceed with the removal of the pathological tissue. Constant monitoring and the patient's real-time feedback guide us in making decisions during surgery and ensure we stay within safe margins. For example, if we're removing a tumor, their responses help us determine how much tissue can be safely removed. This way, we maximize the tumor removal while minimizing damage to healthy brain tissue.


What are the key benefits of awake brain surgery?


Awake brain surgery offers several significant advantages:

  • Preserving Brain Function: It allows us to identify and safeguard critical brain functions, such as language and motor skills, minimizing the risk of post-surgical deficits.

  • Maximizing Tumor Removal: For brain tumor patients, awake surgery often results in more extensive tumor removal, improving long-term outcomes.

  • Other: For epilepsy patients, awake surgery helps to pinpoint the exact areas of epileptic activity that could be removed to achieve effective treatment.

Who is an ideal candidate for awake brain surgery?


The suitability for awake brain surgery varies from patient to patient. It is typically considered for individuals with brain tumors located in or near critical brain regions or for epilepsy patients whose seizures originate in specific areas. The decision is made after a comprehensive evaluation by a multidisciplinary team of experts.


The awake brain surgery is a highly specialized procedure that requires a skilled medical team and careful patient selection.


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