Awake craniotomies are a rare and risky type of procedure. However, it may be necessary to save a patient’s life when operating on delicate parts of the brain such as Broca’s area which is involved in speech. It is important to be able to monitor a conscious patient when operating here to prevent any irreversible injury.
During an awake craniotomy, a patient is placed under deep sedation, in the twilight zone, at the beginning of the procedure. The patient is not awake for the incision or for the removal of a section of the skull. Once the brain is exposed and the surgeons are ready to begin the patient is brought out from under anaesthesia without any other medications. This is due to there being no pain receptors in the brain itself, the patient is totally comfortable with the procedure and does not feel anything going on.
Whilst the surgeons are busy operating, a neuropsychologist or a different person specialised in this field would question the patient and ensure they stay calm. This is extremely important as it is necessary to detect if there is a minuscule change in answer, language or cognitive processing as this could signal a problem with the brain during the operation. This is very important to monitor and would not be possible if the patient was under general anaesthesia.
Patients have been documented playing instruments during awake craniotomies to ensure hand movements and coordination was still intact. Playing the violin while having your brain operated on is some feat!
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