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Wakeful brain surgery

Our brain is the control centre of our body. It controls all our bodily functions. It is thus very important to proceed very carefully during brain surgery so that no important areas are affected (think of speech centres or motor centres performing the movements of arms, legs and face). If a tumour is situated close to these areas, the neurosurgeon will in consultation with the patient opt for a wakeful intervention during the surgical operation for which the patient is awakened so that he/she can carry out simple instructions.

The way in which the brain works and is organised is different for every individual person. For instance, there is already a major difference between left- and right-handed patients. But the lesion or tumour may also shift the control areas in the brain. That's why an individual high-precision approach is crucial.

Using a functional MRI, the different areas of the brain are mapped for every individual patient (mapping and highlighting the areas controlling movements or speech). This mapping can, for instance, be done by having the patient move his/her hand or by testing his/her speech.

But this mapping technique does not give a 100% accurate image of the dangerous brain areas. Accordingly, it is necessary to locate critical areas extra accurately while the patient is awake so that he or she can carry out instructions with his/her hands and fingers, arms and legs and/or face. In addition, the patient must perform several speech exercises. The wakeful part of the operation takes one and a half to two hours.

The main benefit of this way of surgery is that during the operation one has direct control over dangerous areas of the brain so that the risk of permanent damage remains restricted to an absolute minimum. Besides, by combining all different imaging techniques, mapping and wakeful brain surgery, it is now possible to operate tumours that used to be inoperable.

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