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2006 Press Releases

Some Patients Know What It's Like to be Awake During Surgery.

LONG BRANCH, NJ, February 21, 2006 - Do you remember being prepped for surgery and lying on the operating table counting backwards from 10 as the anesthesia began to take effect?

Somewhere between the numbers eight and seven you drifted to sleep, no longer aware of what was going on around you. Then, as if no time had passed at all, you were again awake and aware of the surroundings. You recognized the voice of the neurosurgeon asking if you could hear him.

What you should know about this scenario is that the surgery was not over, it was just beginning.

An awake craniotomy, otherwise known as "awake surgery," is an amazing procedure that seems almost unbelievable at first.

As the name implies, awake surgery allows the patient to remain awake while his or her brain is being operated on.

The newest member of Monmouth Medical Center's Department of Neurosurgery, Ty J. Olson, M.D., has brought to Monmouth a highly effective new form of surgery to treat brain tumors and lesions previously thought to be inoperable or only partially resectable.

Olson, who is one of only a handful of neurosurgeons in the entire country to perform awake craniotomies adds, "Awake surgery is a very useful technique when tumors are near eloquent areas of the brain. Because everyone's brain is unique, anatomy can only give us a general idea of where in the cortex certain critical functions are performed, for example, the ability to comprehend speech or move your right hand.

"When operating in or near vital locations of the brain, we must delineate or "map' exactly where areas of eloquent cortex are, so we can preserve them during our resection."

During awake surgery, the patient is asleep as the surgeon opens the skull to expose the brain tumor or lesion and then awakened from anesthesia for intra-operative testing.

Patients do not experience pain during awake brain surgery because the scalp is numbed with local anesthesia and the brain tissue does not sense itself.

Olson explains, "As the patient is awakened, we place electrodes on the brain surface to record activity and stimulate different areas of the brain. The stimulation deactivates, rather than activates that small area of cortex. While the patient is performing routine tasks, such as identifying pictures, moving his or her hand, counting or answering questions, we stimulate discrete locations to see how the patient performs with that part of the cortex deactivated.

"If the patient is able to continue the task, we know it's not a vital area, but if the patient has trouble with the task, for example stops counting or slurs words, we know it is a vital area that must be preserved."

While the notion of being awake during brain surgery can be frightening at first, most patients like the idea of participating in their own procedure and perform exceedingly well in the operating room. Moreover, operating near vital brain areas with the patient asleep under general anesthesia can be risky.

An area of tumor felt to be in vital tissue may be unnecessarily left for fear of causing a neurologic deficit. Conversely, aggressive resection without mapping may include areas of the cortex necessary for speech or motor movement, leaving the patient with a neurologic deficit and a decreased quality of life.

Olson said after awake surgery, a patient generally stays in the hospital for two to three days. Most patients are able to resume their normal activities in six to eight weeks.

"The results of awake brain surgery are excellent," Olson says. "Because we are able to determine through electrodes and the patient's own actions what areas of the brain are being affected, we can better ensure we remove only the pathologic areas of the brain and leave the healthy tissue intact. This technique allows us to be much more aggressive with tumors previously considered inoperable or too dangerous to resect."

Olson joins Monmouth Medical Center from the Neurological Institute of New York at Columbia Presbyterian Medical Center where he completed a six-year residency in neurosurgery and continues to be on staff.

The Neurosurgery Program at Monmouth Medical Center specializes in the diagnosis, surgical treatment and management of brain, pituitary and spinal tumors. To learn more about awake brain surgery or to contact Olson, call (732) 222-8866.

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