Surgical Procedures: Intraoperative Brain Mapping

What is intraoperative brain mapping?

Intraoperative brain mapping is brain surgery that is done while you are awake. It can also be called “awake brain surgery” or an "awake craniotomy.” The goal of this type of surgery is to decrease damage to certain parts of your brain, such as the areas that control: 

• Speech.
• Sight.
• Movement. 

You and your surgeon will talk about if this is the right type of surgery for you.

How is it done?

Intraoperative brain mapping itself is not painful because there are no pain receptors in brain tissue. You may be given medication to make you sleep and will be given medication to prevent pain while work is being done on your skull bone. Your surgical team will monitor you for any new pain or changes during surgery.

The surgeon will want to find the exact parts of your brain that control speech and movement. To do this, your surgeon will ask you to identify photographs, count, raise a finger, and other motor commands. This is done to help your provider make a map of the parts of your brain that are needed to help your brain work as it should.

When is it used?

Awake brain surgery may be used to treat some types of brain tumors. It may also be used to treat non-cancerous (benign) neurologic conditions where brain surgery is needed, like epilepsy.

What are the risks of intraoperative brain surgery?

There are risks and side effects of this surgery. Risks and side effects may be:

• Reaction to anesthesia. Anesthesia is the medication you are given to help you sleep through the surgery, to not remember it and to help with pain. Reactions can include wheezing, rash, swelling and low blood pressure.
• Infection.
• Bleeding.
• Blood clots.
• Pneumonia (infection in the lungs).
• Stroke.
• Changes in blood pressure.
• Swelling of the brain.
• Seizures.
• Meningitis (inflammation of the membrane around the brain).
• Heart attack.
• Muscle weakness and/or paralysis.
• Cerebrospinal (CSF) fluid leak.
• Memory, balance, vision, hearing, bowel and bladder or speech changes.
• Changes in coordination and/or balance.

What is recovery like?

Your recovery will depend on the type of the procedure you had. Often, a 3 to 7 day hospital stay is needed, some of which is spent in the intensive care unit (ICU). 

A temporary urinary catheter may be needed to drain your urine. You will be told how to care for your surgical incisions and will be given any other instructions before leaving the hospital.

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

Your provider will talk to you about any changes you should make in your activity level. In general, you should:

• Keep your incision clean and dry.
• Follow the instructions you have been given for showering and washing your hair.
• Avoid tub bathing, swimming, or other activities that would put your incision under water for 4 weeks or until you are told by your provider.
• Avoid wearing wigs until about 3 to 4 weeks after surgery. You need to give the incision time to heal. A loose turban or hat is often fine to wear.
• Take pain medications as directed. Speak with your provider before taking aspirin, ibuprofen, or other blood thinning medications.
• Avoid dyeing your hair or getting a perm for at least 4 weeks after surgery.
• Do not put medications/skin products on the surgical incision unless your provider tells you to do so.
• Avoid people who are sick.
• After surgery, do not lift, push, or pull anything more than 10 pounds for 4 weeks.
• Ask your provider about physical activity.
• You can often return to work within 4 to 6 weeks, based on the type of work you do.
• Your provider will tell you when it is safe for you to drive.

What will I need at home?

• Thermometer to check for fever, which can be a sign of infection.
• Wound/incision care supplies.

When should I call my provider?

• If you have a fever. Your provider will let you know when you should call. 
• Any new or worsening pain.
• Redness, swelling, drainage, or bleeding from the incision.
• Shaking chills/shivering.
• Phlegm (mucus) that is green, yellow, or blood-tinged.
• Headaches.
• Stiff neck.
• Changes to your behavior or mental status, 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.
• Nausea/vomiting that does not get better and/or being unable to keep down food or drink.
• Bowel and/or bladder changes, such as being unable to pee or have a bowel movement, and/or being unable to control your bowel and/or bladder.
• Coughing, shortness of breath.
• Leg swelling, tenderness, redness, or warmth.

If you have chest pain or difficulty breathing, call 911 right away.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your provider tells you that it is okay to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection, and/or constipation. Call your provider with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your provider before taking any medications for constipation.

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5 to 10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your provider about your specific plan and recovery.