News Release

AWAKE . . . AS BRAIN SURGERY GOES ON
Patient talks, wiggles fingers as doctor removes tumour

Mississauga, ON - Tony Fava found it “definitely weird”: He was awake while a neurosurgeon worked inside his head to remove a brain tumour. Fava talked away to operating room staff around him, he wiggled his fingers, he joked with people. He felt only a little pain since brain tissue itself has no pain receptors.

“It was strange being awake,” said the 31-year-old plumber. “You knew what was going on but at the same time you didn’t know. You know they’re in there but there’s no pain. I was talking away and asked (medical staff), ‘When are we going to go for a beer?’ “

Fava is among patients at Trillium Health Centre to undergo what is called an awake craniotomy. Few doctors perform the procedure and, until recently, it was used only as an epilepsy treatment. Usually, in 80 per cent or more of cases, the patient is ‘under’ for the entire operation. But improved anaesthetics and brain mapping allow skilled surgeons to get at tumours with the patient conscious.

By having the patient awake, thinking and talking – sometimes joking with operating room staff – neuro-oncology surgeons can make sure they do not excise vital brain tissue along with the cancer cells. They can reduce the operative risk of damaging motor-control areas of the brain. And the belief is they can remove more of the tumour in an awake craniotomy.

“Most craniotomies are done with the patient under general anaesthetic,” says Dr. Arlan Mintz, neurosurgeon at Trillium Health Centre and chair of the Ontario Medical Association section of neurosurgery. “We’re trying to reverse the trend. Every patient is a potential patient for an awake craniotomy.”

In an awake craniotomy, the neurosurgeon removes a small piece of skull cap near where the tumour is located. A restraining device limits head movement. The surgeon then uses a small cortical stimulator, essentially an electric probe, to make contact with brain tissue and nerves around the tumour. And the doctor can ask the patient to perform simple actions, such as wiggling fingers or identifying pictures.

In this way, the surgeon can identify and avoid the eloquent regions of speech, senses and movement. This territory marking is called functional mapping. Typi-cally, the awake part of the entire procedure takes up to half of what might be a three- or four-hour operation. New anaesthetics give operating room staff “the ability to make the patient drowsy and then quickly wake the patient up,” said Dr. Mintz.

While brain tissue itself does not have pain receptors, local anaesthetics are used to control pain in associated areas, such as the scalp and cranial membranes. Once the scalp and skull have been opened, the patient is awakened to allow cortical mapping.

The awake craniotomy procedure has several benefits, including the reduced risk to eloquent brain tissue. In addition, there are fewer complications, less risk of infection and patients are home faster – out of hospital in two days as opposed to five or six days in operations where the patient is under general anaesthetic.

For further information, contact:

Mike Pettapiece

416-777-0368

Roula Giannidis
Public Relations Officer
(905) 848-7580, ext.2708

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