Awake Craniotomy
This is an advanced surgical treatment to remove brain tumors that allows for intraoperative speech and language mapping during the procedure. To ensure the neurosurgeon is treating the correct area of the brain and not disturbing any healthy functional areas, they will ask questions during the operation and monitor the patient's responses and activity occurring in the brain.
Originally, this type of procedure was utilized by epilepsy neurosurgeons. They would remove the section that was causing a patient to experience seizures. Realizing that this technique could also be used for tumor resection, Penn started a collaborative program so neurosurgeons could remove primary brain tumors and certain metastatic brain tumors as well. The benefit of doing an awake craniotomy is that it allows our neurosurgeons to maximize the surgical resection while also minimizing the neurological risks.
With the patient needing to be responsive, anesthetics are handled in a completely different way with these treatments. There are no inhalation agents used like with most other surgeries. This procedure requires intervenes and nerve blocking techniques that the anesthesia team gives to specific areas on the scalp. Not fully putting the patient under allows the neurosurgeon to essentially "wake up" the patient from a sleep state after they've gotten the procedure started so they can interact with them.
Brain Mapping
At Penn we use advanced imaging tools such as fiber-guided tractography and individualized brain maps to locate and safely remove brain tumors. Diffusion Tensor Imaging, or DTI, works by measuring the direction in which fluid moves within the brain, gathering data to help determine the location and function of different brain fiber clusters. Advanced diffusion tractography software then uses that data to produce 2D or 3D maps of the brain that reveal its internal wiring.
The brain is mapped both before and during the surgery. Mapping helps neurosurgeons pinpoint areas of the brain that control different behaviors. It requires a grid of sensors or electrodes positioned only on the surface of the brain to detect electrical signals. The cortical and deep areas of the brain are stimulated while a sophisticated neuromonitoring team collects real-time data, guiding the surgeon. This technology is especially helpful for removing brain tumors and sparing healthy brain tissue in the process.