Imagine Being Awake During an Operation

No, it’s not a story by Stephen King. It’s an “awake craniotomy,” a procedure performed this past March at St. Michael’s by the latest recruit to our Neurosurgery team, Dr. Sunit Das.

It is a way of mapping the brain and monitoring motor functions while removing a brain tumour. It’s also important to remember — if you've started to feel a little queasy reading this — that there are no pain receptors in the brain, so you don’t feel a thing.

“It was clear to me that being able to map the brain improved our ability as surgeons to safely and aggressively perform brain tumour resection.”

The name “awake craniotomy” is a little misleading because the patient is not awake the entire time. The surgeon works collaboratively with the anesthesiologist, bringing the patient back to consciousness once the surgeon has access to the brain. Then the patient can respond to brain stimulation and speak, smile, blink count and move fingers or hands as requested. The object is to remove as much of the tumour as possible without impairing the functionality of muscles or cognition. Being able to monitor a patients responses in this way means that surgeoons can take out much more of a tumour than in traditional surgery.

The patient who benefitted from the procedure at St. Michael’s was a young man in his twenties who had suddenly experienced numbness on the left side of his face and his left leg and hand. His doctor was concerned and, knowing Dr. Das, recomended he come to St. Michael’s. MRI testing revealed a glioma wrapped around the motor cortex and motor fibres, putting the patient in danger of paralysis. In an eight-hour procedure, Dr. Das was able to remove the majority of the tumour, and the young man walked out of the hospital two days later.

“I became interested in awake mapping during residency,” says Dr. Das, who has now done seven procedures here. “It was clear to me that being able to map the brain improved our ability as surgeons to safely and aggressively perform brain tumour resection. I was fortuante to learn how to do these procedures in my training in Chicago. I wanted it to be available to my patients at St. Michael’s as well.”

Another example of the innovative work of our neurosurgery team!