Awake Craniotomy

In some cases, patients may be required to remain awake yet sedated during surgery. This type of surgery is called an awake craniotomy. Surgeons may require a patient to remain awake so that they can monitor a patient’s reflexes and reactions during surgery. An awake craniotomy is usually needed when a brain tumor needs to be removed close to functionally important (eloquent) regions of the brain.

Is my child a candidate?

  • Your child may be a candidate for awake craniotomy if a brain tumor causing epileptic activity is located near or in the functionally important (eloquent) region of the brain.

What testing is needed before surgery?

  • Before surgery, the exact location of the brain where the seizures originate from will need to be identified. This may include:
    • MRI: An MRI uses large magnets, radio waves and a computer to make images of the inside of the body.
    • CT scan: This test uses a series of X-rays and a computer to create images of the inside of the body. A CT scan shows more detail than a regular X-ray.
    • EEG (outpatient): This test records the brain's electrical activity through sticky pads (electrodes) attached to the scalp.
    • EEG (inpatient): Some patients may require a longer EEG to record electrical activity in which case a stay in the epilepsy monitoring unit will be required.
    • MEG Scan: MEG, or magnetoencephalography, is a noninvasive test used to localize seizures and abnormal activity within the brain using magnetic sensors. MEG can also be used to localize areas of the brain that control motor, sensory and language.

How is the surgery performed?

  • Patients will receive a milk sedative before surgery to ensure they are relaxed and calm throughout the procedure. In the operating room, drapes will be placed around the patient’s head, but they will still be able to see, talk and move their arms and legs. The surgeons will then make an incision and remove a small portion of the skull. After the brain has been exposed, surgeons will begin cortical mapping with a small electrical probe. Cortical mapping involves stimulation of the brain to identify important areas. For example, one stimulation may cause an arm or leg to twitch, speech to be prevented or a tingling feeling. This type of stimulation will help surgeons avoid and protect areas of the brain that control important functions. The tumor is then removed, the scalp is replaced and the incision is closed. Surgery typically lasts four to six hours. After surgery, patients will spend two to three days in the pediatric intensive care unit and return to normal activity within one to two weeks.

What are the results of the surgery?

  • Awake craniotomy enables the safe surgical treatment of epileptic foci in the brain, when the lesion is suspected to be in or near eloquent cortex. Brain function is confirmed and preserved in real time in the operating room during brain surgery.
  • Complications can happen during any surgery and there is no cure for epilepsy. Awake crainiotomies are typically successful with most patients remaining seizure free for months, years and even decades.
To learn more about the Epilepsy Center at Texas Children’s Hospital and to inquire about admissions and patient candidates, please contact 832-822-0959.