What I Treat
Awake Craniotomy
Brain surgery while awake
The idea of being awake during brain surgery unsettles most people the first time they hear it. In practice, it is one of the safest ways to remove a tumour that sits close to the parts of the brain controlling speech or movement, because it lets the surgical team ask a simple question throughout the operation, in real time, in the only way that actually works: 'Can you still do this?'
The rationale
Why awake?
When a tumour is near areas controlling speech, movement, or sensation, keeping the patient awake allows real-time testing while the surgeon works. The brain has no pain receptors — the scalp is numbed, the skull opened — you feel nothing. Consciousness lets us map what can and cannot be safely removed.
Without this feedback, the surgeon works without a functional margin of safety. An awake craniotomy transforms a blind resection into a dialogue between surgeon and patient, where every millimetre of tissue is tested before it is removed.
Preparation
Pre-operative mapping
Functional MRI (fMRI)
Shows which parts of the brain activate during specific tasks such as naming pictures, reading words, or moving a hand. This provides a preoperative roadmap of eloquent cortex.
Diffusion tensor imaging (DTI)
Maps white-matter connections — the brain's wiring — showing the relationship between the tumour and critical fibre tracts that carry language, movement, and sensory information.
Neuropsychology
Establishes baseline cognitive function before surgery. This helps the team interpret intraoperative responses and measure any postoperative change against a known starting point.
Intraoperative
The procedure
An awake craniotomy follows a carefully orchestrated sequence designed to maximise tumour removal while preserving essential neurological function.
Asleep for opening
General anaesthesia is administered. The scalp is numbed with local anaesthetic. A craniotomy is performed and the skull is opened. You are comfortable and unaware during this stage.
Awake for mapping
Anaesthesia is lightened and you are woken. A speech therapist is in the room, asking you to name objects, count, and move your hand while the surgeon stimulates the cortical surface. You speak, you listen, you respond — and the surgeon maps what is safe to remove.
Asleep for closing
Once the tumour has been resected and the critical areas have been respected, anaesthesia is deepened again. The bone flap is secured, the scalp is closed, and you wake in recovery.
Duration
Procedure typically lasts 4 to 6 hours.
Postoperative
Recovery
- HDU one night for observation — close neurological monitoring is routine after any craniotomy
- Ward for 2 to 4 more days — the neurosurgical team and therapists assess your progress daily
- Recovery is usually faster than many people expect — most patients are surprised by how quickly they feel themselves again
The alternative
The main alternative is surgery under general anaesthesia throughout. For tumours in non-eloquent areas — those not controlling essential functions such as speech or movement — this is standard. The choice between awake and asleep surgery depends entirely on tumour location and its relationship to critical brain regions.
Medical disclaimer: The information on this page is for general educational purposes only. It is not a substitute for individual medical advice, diagnosis, or treatment. Always consult your own doctor or specialist with any questions you may have regarding a medical condition.
Explore More