Awake craniotomy with brain mapping

Awake craniotomy with brain mapping is a procedure in which a neurosurgeon maps and analyzes brain activity before and during surgery. This ensures that the parts of the brain controlling speech, movement, vision, cognition, and sensation are not permanently affected while the operation is being performed.

Mostly used in the treatment of brain tumors, awake craniotomy allows surgeons to know how much of the tumor they can remove without affecting the surrounding healthy brain tissue.

Like other types of craniotomy surgeries, the procedure involves temporarily removing a small section of the skull, often referred to as the bone flap, so surgeons can more easily access the section of the brain being treated.

Penn Medicine is a national leader in awake brain mapping. Our surgeons perform hundreds of awake craniotomy procedures each year using the most advanced surgical techniques to help patients achieve the best possible outcomes.

Awake brain craniotomy can be an effective treatment for patients with tumors in or near regions of the brain controlling language, sensation mobility, and other critical functions. Eligibility for any type of craniotomy depends on each patient’s individual care needs, medical history, and the size and location of the tumor. The tumors usually considered for awake brain surgery are those embedded in the brain, also known as intrinsic tumors.

Brain mapping is considered the gold standard for brain tissue preservation during tumor surgery. It helps surgeons remove as much of the tumor as possible while leaving the surrounding brain tissue intact. Your care team can help you decide if awake craniotomy is the right treatment option for you.

Awake brain mapping requires you to stay conscious so you can answer questions and participate in exercises to help your surgical team mark areas of your brain that correspond with specific activities. Although you will be awake, you will be given a local anesthetic to ensure you don’t feel any pain.

The procedure starts with surgeons carefully removing the bone flap so they can access the area of the brain that needs attention. These locations could be anywhere, including the front of the skull near the hairline, near the temple, or toward the back of the head.

Your surgeon will then begin mapping your brain by stimulating the tissue around the tumor with small electrical pulses. These pulses cause different responses depending on the area of the brain they impact. For example, a pulse to the area that controls mobility may result in arm or leg movement. These pulses will not cause any pain, but you may feel a tingling sensation when certain parts of the brain are activated.

Your surgeons will ask you questions, have you count to a certain number, and engage you in other exercises so they can see which areas of tissue affect speech and cognition. Once the exercises are complete, they will place a small marker in the area of the brain that was active during the exercise.

While your brain is being mapped, your surgical team will remove as much of the tumor as possible knowing exactly what areas of tissue to avoid.

Awake brain mapping usually takes about four to six hours but can vary based on the size and location of the tumor, and any complications. Your neuroanesthesiologist will monitor you throughout surgery to keep you comfortable and ensure you’re not in pain, while your entire surgical team performs the procedure with the greatest care and precision. 

Full recovery from any type of craniotomy surgery generally takes around six to eight weeks but can vary based on your ongoing care needs and any post-treatment complications that may arise. Patients usually remain in the hospital for five to seven days following the procedure.

Your care team will advise you on the need for follow-up visits and the next steps in your treatment. You’ll likely need to avoid strenuous physical activity until your doctor lifts these restrictions and you can return to your regular activities. 

Awake craniotomy limits the risks and long-term complications commonly associated with brain surgery. Most patients make a full recovery and experience no further issues after the recovery period. There are, however, some possible risks such as:

• Nausea and vomiting
• Pain and headache
• Hypertension
• Seizure and stroke
• Movement and mobility issues
• Cognitive impairment  

Your care team will discuss risks and complications with you before moving forward with treatment. You’ll have a chance to get answers to any questions you have so you’ll feel confident about your treatment plan. 

The nationally recognized brain surgeons at Penn Medicine have been at the forefront of brain mapping for years and continue to drive innovation in tumor care. We use advanced imaging tools such as fiber-guided tractography and individualized brain maps to locate and safely remove brain tumors. Our neuromonitoring team uses this real-time data to guide the surgeon during the procedure.

Throughout your treatment, you’ll have a dedicated team of neurology specialists working together to ensure the most thorough and compassionate care before, during, and after your surgery.