When you hear the word “surgery,” what comes to mind? You probably think about being put to sleep with anesthesia, and waking up with the surgical procedure finished.
For some types of brain surgery it’s actually helpful for the patient to be awake during the procedure—not only awake, but communicating with the surgical team.
The “eloquent regions” of the brain are the regions that control functions like speech, vision, feeling, and movement. A brain tumor or epileptic focus in or near one of these areas presents a special challenge to the neurosurgeon, to remove as much of the tumor or epilepsy causing region as possible while preserving those functions.
Unfortunately our brains don’t come with these areas clearly marked. Neurosurgeons need a guide to help them identify these eloquent regions.
This type of surgery starts with the patient sedated and under anesthesia, without needing a breathing tube. While the patient is asleep Dr. McKhann makes an opening in the skull and gets her ready for the next part of the procedure.
He then allows the patient to wake up. The patient doesn’t feel any pain, but she is actually awake and able to talk to the surgeon. Dr. McKhann stimulates different areas of the brain while the patient carries out language or motor tasks, like answering questions or reciting a list. This allows Dr. McKhann to make a map of the parts of the brain responsible for those functions. If the patient begins to have trouble doing one of the tasks, the surgeon knows to avoid that area of the brain.
Dr. McKhann brought his expertise in awake brain mapping to the 2015 meeting of the Congress of Neurological Surgeons (CNS) this fall. He directed and moderated a forum called “Surgical Management of Tumors in Eloquent Regions.” He has taught this course several times over the past few years, and it remains a big draw for neurosurgeons who want to learn more about brain mapping.
His course at CNS covered planning for surgery in the eloquent regions of the brain, as well as current technologies for brain mapping and how they can be used to enhance the safety of surgery.
You can learn more about Dr. McKhann’s presentations on awake brain mapping at previous CNS meetings at the following links:
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