What is intraoperative brain mapping?

Intraoperative brain mapping is brain surgery that is done while you are awake. It can also be called “awake brain surgery” or an” awake craniotomy.” The goal of this type of surgery is to lessen any damage to important parts of your brain. Some important areas of your brain are the ones that control speech, sight, and movement. You and your surgeon will talk about if this is the right type of surgery for you.

How is it done?

You may or may not be awake while the skull bone is being removed and placed back on. You will be given medication to prevent pain while work is being done on your skull. Intraoperative brain mapping is not painful for you, as there are no pain receptors in the brain tissue. Your healthcare team will monitor you for any new pain or changes during surgery.

The surgeon will want to find the precise parts of your brain that control speech and movement. To do this, your surgeon will ask you to identify photographs, count, raise a finger, and other motor commands. This is done to help your provider make a map of the parts of the brain that are needed to help your brain work as it should.

When is it used?

Awake brain surgery may be used to treat some types of brain tumors. It may also be used to treat non-cancerous (benign) neurologic conditions where brain surgery is needed, like epilepsy.

What are the risks of intraoperative brain surgery?

There are risks and side effects of this surgery. Risks and side effects may be:

Reaction to anesthesia (Anesthesia is the medication you are given to help you sleep through the surgery, to not remember it and to help with pain. Reactions can include wheezing, rash, swelling and low blood pressure).
Infection.
Bleeding.
Blood clots.
Pneumonia (infection in the lungs).
Stroke.
Changes in blood pressure.
Swelling of the brain.
Seizures.
Meningitis (Inflammation of the membrane around the brain).
Heart attack.
Muscle weakness and/or paralysis.
Cerebrospinal (CSF) fluid leak.
Memory, balance, vision, hearing, bowel and bladder or speech changes.
Changes in coordination and/or balance.

What is recovery like?

Recovery will depend on the extent of the procedure you have had. Often, a 3 to 7 day hospital stay is needed, some of which is spent in the intensive care unit (ICU). A temporary urinary catheter may be needed to drain your urine.

You will be told how to care for your surgical incisions and will be given any other instructions before leaving the hospital.

Your care team will talk with you about the medications you will be taking, such as those for pain, blood clot, infection, constipation, and seizure prevention, and/or other conditions.

Your provider will talk to you about any changes you should make in your activity level. In general, you should:

Keep your incision clean and dry.
Follow the instructions you have been given for showering and washing your hair.
Avoid tub bathing, swimming or other activities that would put your incision under water for 4 weeks or until you are told by your healthcare team.
Avoid wearing wigs until about 3 to 4 weeks after surgery. You need to give the incision time to heal. A loose turban or hat is often fine to wear.
Take pain medications as directed. Speak with your healthcare team before taking aspirin, ibuprofen or other blood thinning medications.
Avoid dyeing your hair or getting a perm for 4 weeks after surgery.
Do not put medications/skin products on the surgical incision unless your healthcare team tells you to do so.
Avoid being around people who are sick.
After surgery do not lift, push or pull anything more than 10 pounds for 4 weeks.
Ask your provider about physical activity like exercising.
Often you can return to work within 4 to 6 weeks, based on the type of work you do.
Your healthcare team will tell you when it is safe for you to drive.

What will I need at home?

Thermometer to check for fever, which can be a sign of infection.
Wound/Incision care supplies.

When should I call my provider?

If you have a fever. Your provider should tell you at what temperature you should give them a call.
Any new or worsening pain.
Redness, swelling, drainage or bleeding from the incision.
Shaking chills/shivering.
Phlegm (mucus) that is green, yellow or blood-tinged.
Headaches.
Stiff neck.
Behavioral changes and/or mental status changes, confusion and/or depression.
Drowsiness, fainting and/or seizures.
Vision changes.
Balance, strength or movement changes.
Facial, arm or leg numbness, tingling and/or weakness.
Nausea/vomiting that does not get better and/or being unable to keep down food or drink.
Bowel and/or bladder changes, such as the inability to pee or have a bowel movement and/or the inability to control your bowel and/or bladder.
Coughing, shortness of breath, problems breathing and/or chest pain.
Leg swelling, tenderness, redness or warmth.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.

Surgical Procedures: Intraoperative Brain Mapping