Back to Top Awake Brain Surgery: Your questions answered - The Ottawa Hospital


Awake Brain Surgery: Your questions answered

A model of the inside of a human brain

Although all human brains have the same general structure, the exact location of specific functions, such as speech,  language comprehension even fine movements such as wiggling fingers, is slightly different in everyone. Small electrical impulses are put on the surface of the brain to help “map” it so that the neurosurgeon can try to avoid that area.

What is awake brain surgery?

Awake brain surgery, also known as an awake craniotomy, is a type of operation performed on the brain while the patient is alert and fully awake. 

What kinds of patients might need awake brain surgery?

Awake brain surgery is used to treat patients who have certain types of brain tumors or lesions that may cause epileptic seizures.  About 50 to 60 awake craniotomies are performed every year at The Ottawa Hospital, with most of them aiming to remove brain tumors that are located close to the part of the brain related to speech or movement.  These parts of the brain are known as eloquent regions of the brain.

Does it hurt?

A specialized neuro anesthesiologist will give medications at the beginning of the surgery to make the patient sleepy and then give local anesthetic to ensure that the opening of the scalp and skull is relatively painless.  Once the brain is exposed the patient is awoken. 

Awake brain surgery is often a frightening prospect for every patient. The excellent team of surgeons, neuro anesthesiologists, nurses and  allied health workers at The Ottawa Hospital deliver compassionate care  to make each patient’s experience as easy as possible. 

What does a patient experience during the awake brain surgery?

Dr. Safraz Mohammed
Dr. Safraz Mohammed, a staff neurosurgeon at The Ottawa Hospital and Director of Undergraduate Education (Neurosurgery) at the University of Ottawa,  is one of nine neurosurgeons at The Ottawa Hospital,  who perform awake brain surgery

Once the patient is awake in the operating room, it’s time to “map” the brain.  Everyone’s brain is a little different, so it’s important to know the exact location of different functions like language and movement of different parts of the body.

I would usually ask my patients to count backwards from 20, or to look at a picture of a simple everyday objects and say its name.  As they do these tasks, I carefully apply a special electrode to a specific location on the surface of the brain. Then a small electrical current is put through the electrode for one to two seconds.  This electrical current temporarily stops that particular part of the brain from functioning for that brief time.

I observe the patient carefully as I apply the electrode to different areas of the brain.  If the patient suddenly stops speaking, then  I suspect that the location of the electrode is also a part of the brain necessary for language. 

I will further test this area of the brain to confirm that it is responsible for language. Then I know to avoid this area of the brain during my operation to remove the brain tumor. For more on mapping the brain’s language centres, read the story of Ron Wulf, a linguist who needed awake brain surgery to remove a brain tumour

I would ask my patients to lift up their hand and wiggle their fingers, as I use the electrode again to map which part of the brain is responsible for this action.  When the patient stops wiggling their fingers or their hand drops on the bed then I am able to identify the motor centre of the brain responsible for hand movement.  I do to same to map leg movements.

In this way I can map out certain functions of the brain in real time.  By knowing which areas are important for speech and movement I avoid these areas as best as I can, while trying to take out all or most of the tumor.

How long does it take to go home after awake brain surgery?

In my practice, more than half of my patients who undergo an awake brain surgery will go home the very next morning.  Some may have to stay a day or two longer in order to be monitored.  My hope in the future is to be able to have the resources required to discharge the awake brain surgery patients on the same day of surgery.  So, patients can have a brain tumor removed in the morning can have the afternoon tea in the comfort of their own home.


Comment on this post

Your email address will not be published. Required fields are marked *


You might also like…

A team from The Ottawa Hospital helps organize first-ever oncology conference in the North

When it comes to cancer treatment, there’s no place like home. This spring, a team from The Ottawa Hospital helped organize Nunavut’s first-ever oncology conference to figure out how to bring oncology care closer to home for patients.

Second Chance: Don’s song for the people who saved his life

Making music has always been a big part of Don’s life, so when the staff and doctors at The Ottawa Hospital saved him from the brink of death, he could think of no better way to thank them.

A land acknowledgement that honours the land and the medicines it provides

Visitors to The Ottawa Hospital are now greeted by a prominent land acknowledgement, which has been installed by the main entrances at each of our three main campuses. It is paired with artwork by Simon Brascoupé and his daughter, Mairi Brascoupé, both from Kitigan Zibi Anishinabeg.

“Stewards of hormones”: Our Gender Diversity Specialty Clinic guides medically complex patients on their affirmation journey

Often, trans and non-binary patients struggle to find health-care providers to support them on their affirmation journey. It is even more difficult for patients with complex medical needs. That’s why we launched our Gender Diversity Specialty Clinic, one of the first of its kind in Canada.

After a life-altering bike crash, this group of volunteers proves that friendship and community are powerful medicine

In September 2021, a visiting professor woke up in our ICU completely alone. He admits that he wouldn’t have made it through the first few months without support. But he didn’t have to, thanks in large part to a group of caring volunteers who came to his side during this difficult time—and have been there ever since.

“My craft is to make people happy”

As a shuttle bus driver at The Ottawa Hospital, Bill Nauffts knows that staying on schedule could literally be the difference between life and death—but it’s what Bill does during his break that brings him and others the greatest joy.

This website gives you common facts, advice and tips. Some of it may not apply to you. Please talk to your doctor, nurse or other health-care team member to see if this information will work for you. They can also answer your questions and concerns.