Learn how awake brain surgery can make treatment safer and more effective for some patients.
Neurosurgeon Viviane Tabar uses advanced imaging technologies to remove as much of a low-grade glioma as possible while preserving your ability to function normally.
New technologies have made brain surgery — usually the most effective treatment for people with low-grade glioma — safer than ever before. At Memorial Sloan Kettering, we typically use surgery to diagnose as well as treat low-grade glioma.
Studies suggest that the outcome for people who undergo brain surgery is better the more a doctor performs the procedure; MSK neurosurgeons operate on more than 600 patients with brain tumors each year,
Based on your individual situation, we’ll use one of the following approaches and techniques:
- Functional MRI Brain Mapping
A functional MRI (fMRI) can help your surgeon plan the best course for your surgery. This imaging test is done a few days before surgery. An fMRI can make a map of your brain. During the fMRI, you’ll do simple tasks, such as moving your hands and feet or counting in your head. The results show your surgeon which parts of your brain affect such functions as vision, speech, touch, and movement, and whether your tumor may affect those parts. An fMRI can help your surgeon figure out how much of the tumor to remove.
- MRI During Surgery
Your neurosurgeon can use MRI technology at any time during a procedure to help the team determine whether all of the tumor tissue has been removed. If any tumor tissue is left over, your surgeon can resume surgery to remove it.
Using MRI to reevaluate the tumor during surgery enables your neurosurgeon to operate with precision and deal smartly with potential complications if they come up.
- Surgical Navigation
Surgical navigation, also called frameless stereotaxy, helps us plan out your operation. It functions as a guide during the operation itself.
With this approach, technicians attach adhesive plastic dots around your scalp before the operation begins. They then use MRI images to map the exact location of the dots as information about the position of your head is sent to a computer. In the operating room, an image is projected on a screen that is synchronized with the MRI, generating real-time information about the position of your brain and the tumor.
Surgeons use a viewing wand to see the tumor’s outermost edges. This increases the likelihood that they remove every last piece of the tumor is removed, if possible. The benefits of this procedure include better accuracy plus the potential for a smaller incision (cut) and a shorter surgery.
- Awake Surgery
Awake craniotomy, or awake surgery, is an advanced surgical procedure that we use if your tumor is close to a delicate part of the brain. The team gives you local anesthesia and medication to sedate you while keeping you conscious.
Electrodes stimulate the surface of your brain and help us identify the delicate parts that must be kept safe. During parts of the procedure, your surgeon wakes you up to have you speak or do movements that can help guide tumor removal.
Depending on where your low-grade glioma is located, you may be a candidate for neuroendoscopy, a minimally invasive surgery. Your surgeon uses a smaller incision (cut) than in conventional surgery, and operates within that opening. A thin tube with a powerful lens, a high-resolution video camera, and specialized surgical instruments help your surgeon complete the procedure. This type of “microsurgical procedure” usually results in less injury to healthy tissue during surgery.
When we remove part or all of a tumor, you may notice relief from pressure on the skull. Your ability to speak and move normally may come back, since these tumors often start in the parts of the brain that control those functions.
If your tumor is too risky to operate on, meaning surgery could damage other parts of your brain, we may recommend chemotherapy or other treatment options.