Awake Craniotomy

When a tumor is near critical speech areas of the brain, it may be important to determine the exact location of these speech-related areas
Although functional MRI (fMRI) can show the various areas of activation during speech functions, it does not pinpoint the most important areas. These critical areas must be located using special speech mapping techniques while the patient is awake in the operating room.
Awake speech mapping involves applying mild electrical current to the surface of the exposed brain while the patient performs various tasks, such as reading. If the stimulation hinders the task, then that area of the brain is marked and preserved.

UCLA has pioneered the technique of sleep-awake-sleep craniotomy.
The operation is begun while the patient is deeply asleep under general anesthesia (on a breathing machine). This is for the comfort of the patient and is safer.
When the brain is exposed and the neurosurgeon is ready to begin mapping the speech areas, UCLA neuroanesthesiologists carefully lighten the sedation, and then remove the breathing tube and allow the patient to talk and interact with the neuropsychologist.
Typically, the patients feel minimal or no discomfort while awake
Once the speech mapping is complete, often the tumor is removed while the speech testing continues. The procedure lessens the risk of undercutting the white matter fibers connecting speech areas.
When appropriate, the anesthesiologist skillfully places the patient back under general (deep) anesthesia, allowing the neurosurgeon to complete the operation safely with no discomfort to the patient.

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