Surgical Procedures: Intraoperative Brain Mapping

Lori Smith, CRNP
Last Modified: October 13, 2017

What is intraoperative brain mapping and how is it performed?

Intraoperative brain mapping, also referred to as awake brain surgery or an awake craniotomy, is a way to perform brain surgery while the patient remains awake. The goal of this type of surgery is to minimize damage to important areas of the brain, such as areas that control speech, sight, and movement. This type of surgery allows the surgeon to work on an area of the brain that might otherwise be thought to be too close to the areas that control these important functions and helps minimize damage to those areas.

During this procedure, patients are typically sedated with general or a more mild form of anesthesia for the parts of the operation where the skull is opened or closed. In some cases, the patient will be given pain medication and local anesthesia to remain awake during the entire procedure. The procedure is not painful for the patient, as there are no pain receptors in the brain tissue itself. In addition, the patient is monitored by an anesthesiologist for any pain.

The patient is awakened during the operation so they can follow commands, including speech and movement, while the brain is probed with a mild electrical current. Commands may include things like photograph identification, counting, raising a finger and other motor commands. If the patient is experiencing difficulty with a command, that area of the brain is avoided and preserved. 

Awake brain surgery may be used in some cases of brain tumors or the need to obtain a brain biopsy. It may also be recommended in non-cancerous neurologic conditions that require brain surgery, including epilepsy.

What are the risks associated with craniotomy?

As with any surgical procedure, there are risks and side effects associated with undergoing intraoperative brain mapping or awake craniotomy. Risks and side effects associated with the procedure are specific to the area of the brain being operated on. These can include:

  • Risks associated with general anesthesia, including reaction to the medication
  • Infection
  • Bleeding
  • Blood clots
  • Pneumonia
  • Stroke
  • Blood pressure instability
  • Swelling of the brain
  • Seizures
  • Meningitis
  • Heart attack
  • Muscle weakness and/or paralysis
  • Cerebrospinal fluid leak
  • Memory, balance, vision, hearing, bowel and bladder or speech deficits/difficulties
  • Changes in coordination and/or balance
  • Coma
  • Death

What is recovery like?

Recovery from an awake brain mapping procedure will depend on the extent of the procedure performed. Typically, a 3-7 day hospital stay is required, some of which is spent in the intensive care unit. A temporary urinary catheter may be draining your urine after surgery.

You will be instructed on how to care for your surgical incisions and will be given any other instructions prior to leaving the hospital.

Your medical team will discuss with you the medications you will be taking, such as those for pain, blood clot, infection, constipation, and seizure prevention, and/or other conditions.

Although your healthcare provider will discuss your particular activity restrictions, generally it is advised that you:

  • Follow your healthcare provider’s incision care instructions. Be sure to keep the surgical incision clean and dry.
  • Bathe as directed by your healthcare team. You may be asked to wash your hair daily.
  • Avoid tub bathing, swimming or other activities that would submerge your surgical incision for 4 weeks or until advised by your healthcare team.
  • Avoid wigs until about 3 to 4 weeks after surgery, as it will take time for your surgical incision to fully heal. A loose turban or hat is typically fine to wear.
  • Take pain medications as directed; speak with your healthcare team before taking aspirin, ibuprofen other blood thinning medications.
  • Avoid dying your hair or getting a perm for 4 weeks after surgery.
  • Avoid putting topical medications/skin products on the surgical incision unless your healthcare team advises you to do so.
  • Avoid being exposed to people who have the cold, flu or other respiratory infections.
  • Avoid exposure to second hand smoke, fumes and environmental pollution.
  • Avoid heavy lifting, pushing or pulling. Following surgery do not lift, push or pull anything more than 10 lb for 4 weeks.
  • Advance your physical activity gradually. Rigorous activity and regular exercise should be avoided for 4 weeks. Do not perform any activities that would pose a risk for head trauma, like skiing, contact sports, etc, for 8 weeks or until advised by your healthcare team.
  • Typically you can return to work within 4-6 weeks, depending on your particular situation.
  • Your healthcare team will discuss with you when it is safe for you to drive.

What will I need at home?

  • Thermometer to check for infection
  • Wound/Incision care supplies

When to call your doctor

Contact your healthcare team with any of the following symptoms including:

  • Fever of >101 degrees F
  • Unrelieved pain
  • Redness, swelling, drainage or bleeding from the incision
  • Shaking chills/shivering
  • Phlegm which is green, yellow or blood-tinged
  • Persistent headaches
  • Stiff neck
  • Behavioral changes and/or mental status changes, confusion and/or depression
  • Drowsiness, fainting and/or seizures
  • Vision changes
  • Balance, strength or movement changes
  • Facial, arm or leg numbness, tingling and/or weakness
  • Persistent nausea/vomiting and/or the inability to keep down food or drink
  • Bowel and/or bladder changes, including the inability to urinate or have a bowel movement and/or the inability to control your bowel and/or bladder
  • Coughing, shortness of breath, problems breathing and/or chest pain
  • Leg swelling, tenderness, redness or warmth

How Can I Care for Myself?

Depending on the extent of your surgery, you may need a family member or friend to help you with your daily tasks until you are feeling better and your medical team gives you the go ahead to resume normal activity.

Be sure to take your medications as directed to prevent pain, infection and/or constipation and call your medical team with any concerning symptoms.

If you experience constipation, diet modifications, increased fluid intake, and over-the-counter medication, such as docusate sodium or Milk of Magnesia to relieve constipation may be helpful. Speak with your healthcare team for additional recommendations or if you do not have a bowel movement for three days or more.

Deep breathing and relaxation are important to help with pain, keep lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to perform deep breathing and relaxation exercises several times a day in the first week, or whenever you notice you are particularly tense.

  • A simple exercise to do on your own: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.
  • Find more relaxation exercises on OncoLink.

This hand-out provides general information only. Please be sure to discuss the specifics of your surgical plan and recovery with your surgeon.

References

Neurology and Neurosurgery. Retrieved from http://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/ionm/types/intraoperative-brain-mapping.html on September 21, 2017

Awake Brain Surgery: Overview. Retrieved from http://www.mayoclinic.org/tests-procedures/awake-brain-surgery/home/ovc-20247843 on September 21, 2017

Awake Brain Surgery: Why its done. Retrieved from http://www.mayoclinic.org/tests-procedures/awake-brain-surgery/details/why-its-done/icc-20247851 on September 21, 2017

Awake Brain Surgery: Risks. Retrieved from http://www.mayoclinic.org/tests-procedures/awake-brain-surgery/details/risks/cmc-20247858 on September 21, 2017

Awake Brain Surgery: What you can expect. Retrieved from http://www.mayoclinic.org/tests-procedures/awake-brain-surgery/details/what-you-can-expect/rec-20247862 on September 21, 2017

Awake Brain Surgery. Retrieved from http://www.pbs.org/pov/englishsurgeon/awake-brain-surgery/ on September 21, 2017

Surgical Procedures: Craniotomy. Retrieved from https://www.oncolink.org/cancers/brain-tumors/treatments/craniotomy on September 21, 2017

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