Brain Surgery: Awake


MIAMI, Fla. (Ivanhoe Newswire) – Imagine being out of the country and needing life-saving surgery – it happened to one dad while on vacation with his two young boys. It turns out, the sun and fun combined with the heat and exhaustion added up to a perfect storm. This young father ended up in brain surgery awake and talking to surgeons.

Both boys are Fernando Vera’s reason for living, and that was never more clear than last Father’s Day when the family was on vacation in the Dominican Republic and something terrible happened.

Fernando recalls, “As I entered the arcade, I started twitching on my left side, and then I bit my tongue to bleed and foam up and slowly fell down.”

Fernando felt like he was leaving his body. Rushed to the ER and then flown back to Miami, Fernando was diagnosed with a cerebral vascular malformation.

“Which is a collection of blood vessels that creates a ball. And those collection of blood vessels can cause bleeding or in the brain or seizures,” explains Neurosurgeon at University of Miami Miller School of Medicine, Robert Starke, MD.

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Dr. Starke says each time Fernando had a bleed, the more likely he would have another, causing more damage to his brain each time. His best option – surgery to remove it.

“If we do this surgery awake, I’m able to stimulate those areas to carefully identify where are the speech centers and where are the seizures coming from,” Dr. Starke adds.

In a video of Fernando’s surgery, a resident is keeping the conversation going for hours. Fernando is not in pain but being able to converse with the surgeon insures the success of the procedure.

Dr. Starke mentions, “We use a huge microscope that’s bigger than, you know, all of us put together to make a tiny opening and go in and remove this malformation.”

The surgery was a success! Fernando went home two days later and hasn’t had a seizure since. Looking back, Fernando believes he had two seizures before the one in the Dominican Republic but never realized what they were and thought they were a reaction to what he ate or an extreme workout. Although awake surgery for brain tumors is somewhat common, awake surgery for vascular malformations is extremely rare. Due to the proximity to the section of the brain that controls speech, the surgeries are safer when carried out awake.

Contributors to this news report include: Marsha Lewis, Producer; Matt Goldschmidt, Videographer & Editor.

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REPORT:        MB #5344

BACKGROUND: Awake surgery for brain tumors, also known as awake craniotomy, is a neurosurgical technique performed while the patient is awake and alert. This procedure allows surgeons to map and monitor brain function in real-time, minimizing the risk of neurological deficits and maximizing the extent of tumor removal. Before the surgery, the patient undergoes thorough preoperative evaluation, including neurological assessment, brain imaging, and functional brain mapping studies to identify critical areas of the brain responsible for speech, motor function, and other important functions. The patient is initially given anesthesia to induce sleep and numbness. Once the skull is opened, anesthesia is reduced, allowing the patient to wake up gradually. Local anesthesia may be applied to the scalp and skull to minimize discomfort. During the awake phase of the surgery, the surgeon stimulates different areas of the brain using a small electrical probe. Continuous communication between the surgical team and the patient ensures that critical areas are spared. Once the tumor removal is complete, the skull is closed using surgical plates, and the scalp is sutured.


DIAGNOSING: Diagnosing the need for awake surgery for brain tumors involves a multidisciplinary approach that includes careful assessment of the patient’s medical history, neurological function, tumor characteristics, and functional brain mapping. The patient’s medical history is thoroughly reviewed to identify any preexisting conditions, previous surgeries, medications, or neurological symptoms that may impact the surgical approach. A comprehensive neurological examination is performed to assess motor function, sensory function, coordination, speech, and cognition. Brain imaging studies are later obtained to visualize the tumor’s location, size, and relationship to critical brain structures. Functional brain mapping studies are next conducted to identify critical areas of the brain responsible for speech, motor function, sensation, and cognition.


NEW TECHNOLOGY: New technology is allowing brain surgeons to engage in Virtual Reality-Assisted Awake Craniotomy.Awake craniotomy with brain mapping by exact electrical stimulation for tumors or related brain regions is a new surgical approach for minimizing the risk of postoperative neurologic deficits and helping to preserve a patient’s quality of life after an operation. These virtual reality headsets that include eye tracking are opening up doors for new possibilities paving the way for these intricate and complex functions and surgeries.



Kai Hill                                     Joanna Palmer    

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Doctor Q and A

Read the entire Doctor Q&A for Robert Starke, MD, Neurosurgeon

Read the entire Q&A