On Cancer: Memorial Sloan-Kettering Experts Discuss Awake Surgery for Brain Tumors

The multidisciplinary team of experts at Memorial Sloan-Kettering’s Brain Tumor Center is among the most experienced in the world, providing treatment options for all types and grades of brain tumors, including the use of innovative surgical techniques.

For some patients with brain tumors located near areas of the brain related to speech or movement, our experts perform surgery while the patient is awake during portions of the procedure.

“Doing awake surgery gives the surgeon and the patient a safety margin, so that we can continue to remove the tumor while confirming that the patient is well and capable of having normal conversation and movement,” says neurosurgeon Viviane Tabar.

Prior to surgery, a functional MRI is performed, which helps guide neurosurgeons during the procedure.

“Functional MRIs, unlike structural MRIs, show functional regions like language areas and motor areas in the region of the tumor,” explains Nicole Brennan, a functional MRI specialist. “We bring those maps into the operating room to guide the surgeon during the awake procedure.”

During the awake surgery, sedative medications allow anesthesiologists to bring patients in and out of consciousness, so patients can speak and move at the appropriate times.

Often, surgeons ask patients to count or name objects, which allows them to map the speech areas of the brain. They also stimulate the brain and watch movements of the arms and legs to map the motor regions. This allows surgeons to plan a path to the tumor that will protect critical functioning.

In the operating room, our experts use surgical navigation – similar to a GPS for the brain – and an MRI scanner.

“The role of the intraoperative MRI is to give us an updated map during surgery,” says neurosurgeon Cameron W. Brennan. “The system is remarkably precise.” The intraoperative MRI ensures that as much of the tumor is removed as possible, and that the motor and speech areas are protected.

“I love operating on difficult tumors and getting them out, but I enjoy interacting with patients the most,” says Philip H. Gutin, Chair of the Department of Neurosurgery.

“I like to look patients straight in the eye after the procedure and tell them that the job was well done, and that this hurdle is behind them,” Dr. Tabar says.