Memorial Sloan Kettering Experts Discuss Awake Surgery for Brain Tumors

VIDEO | 04:00
Learn how awake brain surgery can make treatment safer and more effective for some patients.
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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.”

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.
Viviane Tabar neurosurgeon

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.


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In 2001, I was diagnosed with stage IV brain cancer and had a glioblastoma multiforme removed from my brain. Dr. Tabar was my neurosurgeon. Thanks to her AMAZING abilities, a functional MRI, and God, I am still here almost 12 years later. Although my tumor was very close to my speech center, I am still able to speak and process information successfully. I Thank God, MSKCC, and Dr. Tabar every day for my health and happiness!

I was diagnosed with lung cancer in 2004 which spread to my brain in 2007. I had whole brain radiation and then surgery. Dr. Gutin was wonderful. Before the surgery he he explained the process and with his comforting demeaner he made me feel as comfortable as a person can be who is about to have a hole drilled in his head. I would like to thank everyone at Sloan for not only saving my life but for the manner in which I was treated. They made a difficult time much easier.

As a 10 survivor of NHL, having a auto-transplant in 2002, am keenly aware of what miracles the good doctors at MSKCC perform.

Dr Philip Gutin performed 2 life extending surgeries on my late sister-in-law Kathy Lemeir, allowing her to spend the much appreciated time with her children and family members.. While her passing on March 7, 2012 was truly a sad time for the family, I remember Kathy's effervescence soon after surgery. We all were amazed she was cognizant of her surroundings and able to converse with family members. Dr Gutin was very kind and professional, explaining the procedure and the diagnosis and the treatment to follow.. We are forever grateful to the doctors and the staff at this World Class Facility... June Fairhurst Fay-Cancer Survivor

I am interested in this discussion. Thank you.

My son 38 has been diagnosed with left lobe tumor 5.3 cm. diagnosed Sunday 13th of April still waiting I for biopsy results.
He is the perfect picture of health, Body trainer, does not drink, smoke, does not drink not even coffe.
I suppose i would like to hear positive, what could be done, the biopsy was done at NYC University hospital.

tubar is a angel shes the best if i could give the world to her on a gold platter i would beautiful person i thank god for her wouldnt trust anybody else she is the best !

Linda, thank you very much for your kind words!

My daughter diagnosised with intractable seizures with brain tumor deep in left temporal lobe age 9 subtotally resected with wait and watch pathologist couldn't classify or indentify and grade. Age 14 new/recurrance did another crainiotomy what appeared to be possibly the residual tumor was new thought he got it all wait and watch. She has never been seizure free on all the meds she has been on and now she is 24 with new enhancement. She has deficits from this and again the unable to identify unusual glial/neuronal tumor on 2nd surgery. But states low-grade glioma grade 11 she has been in a dark place for a long time because I wasn't given the proper services and so forth do deal with what she is and has been going through. We would go to cancer center in Cleveland do MRI see neurologist and go home. Now since new enhancement 3 nodules only 1 2x3x2 mm is doubled in size 4x6x4mm?. Residual tumor from 1st surgery was too deep to compeletely resect and again 2nd surgery was new cells anyone can give me information on low grade glioma 11 and what I have to face in the future statistics any information. She needed physchological social everything to deal with what she was suffering inside. I now am educating myself on how I as a mother didn't get her everything she needed

Dear Stephanie, we’re very sorry to hear that your family has been through all this. We recommend that you seek out support for yourself as well as your daughter. It’s important for caregivers to have the support they need. You may be interested in joining Connections, our online community for patients and caregivers. You can learn more at….

If your daughter is able to come to New York for treatment and would like to be seen by someone at MSK, you can call 800-525-2225 or go to for more information on making an appointment. Thank you for your comment, and best wishes to you and your family.

We want to thank Dr.Tabar and her staff at MSK. Dr. Tabar removed a menginoma from between my pituitary gland, optic nerves and carotid arteries. The MRI after surgery showed the tumor was completely removed and the area left pristine. My eye sight I had lost has returned.
Dr. Tabar is a superior brain surgeon!

Dear Kim and Greg, thank you for your kind words. We will forward them to Dr. Tabar. Best wishes to you!

I have two tumors on my brain.
One is called a reft kee cella cyst that one is on top of my head and gives me seeing problems and sometimes speech and I have small seizures. The other one is the size of a pea and it's on my right side behind my right ear.
Nobody seems to have given me any answers.

In June, 2007 I had a Grade 3 Astrocytoma in my left frontal lobe removed by Dr. Tabar using this technique. I am thankful for her expertise. Please relay my sincere thanks to Dr. Tabar!

Dear Andy, thank you for your comment. We’ll share your message with Dr. Tabar. We’re glad to hear you’re doing well!

Do you take tricare son is in the military and I want him to get a second opinion...