Being awake as part of your brain gets sliced, diced, and zapped with electrodes is enough to make anyone’s stomach churn, but the whole process is actually less frightening than you might think. In fact, the patient isn’t even fully awake during all of the surgery. Especially in the beginning and end, when part of the skull is removed and then reattached, the patient is sedated and on the verge of sleep, thanks to general anesthesia and numbing medications applied to the scalp. Their hair is then clipped or shaved and their head is placed in a fixed position to minimize movement when they’re awake.
When the surgeon gains access to their brain and is ready to proceed with the surgery, the patient is woken up and taken off the sedatives that were previously administered. The key is to have patients alert so that they can talk, move, and think, helping the surgeon to identify and avoid functional parts of their brain that are not relevant to the operation.
A 19-year-old musical theater fan who underwent awake brain surgery in 2018 was tasked with humming and repeating clips of songs that were being played for her as she was being operated on. Another patient — a 28-year-old New Yorker named Rachel — regaled her doctor with tales about a trip she and her husband had taken to Cambodia and Thailand during her surgery. She was also given verbal exercises, such as finishing incomplete sentences (“We went to the airport to catch a ____”) and answering questions ( “What does a king wear on his head?”).
“I remember getting onto the operating room table and then nothing else until I woke up during surgery. I remember somebody saying my name. I could tell that I was on some kind of medication, but I could talk and answer questions,” Rachel told the Weill Cornell Brain and Spine Center. “I thought I was falling asleep a couple times but I learned from Dr. Stieg later that they were in an area where I couldn’t speak.”
Though the idea of it might make you queasy, awake brain surgeries are not as harrowing as you’d expect. Patients, including Rachel, routinely comment on how little discomfort they experienced during the operation.
“I wasn’t in any pain and I didn’t feel uncomfortable on the table,” Rachel said.
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