Learn how awake brain surgery can make treatment safer and more effective for some patients.
The goal of brain tumor surgery is to remove as much of the tumor as possible without causing harm to normal tissue. Your MSK neurosurgeon’s top priority is to keep you safe and make sure you have a good quality of life after your operation.
As a surgical patient at MSK, you will be cared for by one of the most experienced neurosurgery teams in the United States. Our surgeons perform more than 800 brain tumor operations each year. Learn more about our neurosurgeons specializing in brain tumors.
Improvements in surgical techniques and imaging technologies have revolutionized brain surgery in recent years. Our neurosurgeons take a multidisciplinary approach to care and employ the most-advanced surgical technologies, including:
To plan brain surgery, our surgeons use an imaging test called a functional MRI, or fMRI, performed in the days before the procedure. This is a specialized MRI that can create a functional “map” of your brain. During the MRI, you are asked to perform simple tasks such as moving your hands and feet, counting in your head, or thinking of words that begin with a particular letter.
These tests result in a scan that can show which areas of your brain are important to everyday functions such as vision, speech, touch, and movement. From this scan, your surgeon can determine whether the tumor involves these functional areas of the brain and figure out how much of the tumor can be safely removed during the surgery.
In some cases, the tumor is so close to a delicate area that the surgeon also performs mapping of the brain during the operation. Electrodes are used to stimulate the brain surface and identify with great precision the areas of the brain that are involved in specific tasks and that therefore need to be preserved.
Memorial Sloan Kettering’s neurosurgeons perform brain surgery in an operating room equipped with an MRI scanner. At any point during surgery, the neurosurgeon can perform an MRI to determine whether the tumor has been removed completely. If the surgeon finds any remaining tumor tissue, surgery can be resumed immediately to remove it.
The power to reevaluate a patient’s tumor with MRI during surgery enables neurosurgeons to operate with remarkable precision and remove as much of the brain tumor as possible. It also reduces the risks that might result from a second operation. Operations performed using intraoperative MRI are likely to reduce tumor recurrence rates and minimize complications.
Our surgeons also use a very precise technique called frameless stereotaxy – sometimes referred to as surgical navigation — to plan operations and guide the team during surgery.
Technicians begin by attaching six plastic self-adhesive dots around the scalp prior to surgery. At the start of surgery, they register the exact location of these dots via MRI and then relay the position of your head to the computer system.
The team directs a wand-like viewing device at the brain, which then projects an image onto a monitor in the operating room. The image is synchronized with the MRI scan, giving your neurosurgeon up-to-the-moment orientation during the procedure. The neurosurgeon can also use the viewing wand to help identify the outermost edges of the tissue to be removed, known as the tumor margins. This helps the surgeon to remove the entire tumor whenever possible.
Advantages of surgical navigation include enhanced accuracy and greater likelihood that the operation can be done by using a smaller incision. The operation may also be shorter in length as a result. This technique is used in conjunction with Memorial Sloan Kettering’s intraoperative MRI.
Awake brain surgery, or awake craniotomy, is a surgical technique used for some patients with primary brain tumors. In this procedure, you receive local anesthesia and intravenous medications that result in sedation but not loss of consciousness.
During parts of the procedure, you are awakened and asked to speak or to demonstrate certain movements to help guide removal of the tumor, ensuring that areas of the brain critical to speech or movement remain intact.
Neurosurgeons perform certain surgical procedures through a minimally invasive procedure known as neuroendoscopy. Using this technique, only a small opening must be made in the skull. The surgeon performs the operation using a thin tube with a powerful lens, high-resolution video camera, and tiny surgical instruments on its tip.
This minimally invasive procedure enables doctors to use a smaller incision than in conventional surgery, enhances their ability to perform microsurgical procedures, and usually results in less injury to healthy tissue.