Awake Craniotomy: A Delicate Surgery to Protect Language Function

At 58, Gaétan Estève faced a life-altering diagnosis: a brain tumor. To safely remove the tumor, located near the area of the brain controlling language, doctors at Valais Hospital employed a remarkable technique – an awake craniotomy. This procedure involves waking the patient during surgery to continuously monitor language abilities and ensure no critical functions are compromised.

The Challenge: A Tumor Near the Language Center

Gaétan Estève, a passionate coachbuilder, discovered a four-centimeter tumor within his skull after experiencing an unexpected epileptic attack. The tumor’s proximity to the language area presented a significant surgical challenge. Damage to this region could result in speech impairment or loss of language comprehension.

Awake Craniotomy: A Real-Time Assessment

An awake craniotomy, also known as an awake craniotomy, allows surgeons to directly assess a patient’s language function during the procedure. The process begins by carefully reducing anesthesia and pain medication. A speech therapist and neuropsychologist then play a crucial role in monitoring the patient’s cognitive abilities.

“There, we begin to reduce both the drugs that make the patient sleep and the pain medications. This requires more finesse than general anesthesia,” explains Dr. Holger Böhle, anesthetist.

Monitoring Language Function During Surgery

During the surgery, images were displayed on a tablet, and Gaétan was asked to name them aloud – “chair,” “ghost,” “cat.” As long as he could accurately identify the images, the surgeon could safely proceed. The neuropsychologist immediately alerted the surgeon to any signs of language deterioration, allowing for adjustments to be made.

“The neuropsychologist told me each time that there was a small deterioration in language: we stopped, we waited for him to recover, then we started again. This allowed us to go to the limit of what we could do, even as knowing that we were not damaging anything, because we have this permanent control. Which is not possible if the patient is in complete narcosis, we would risk damaging the sense of speech without realizing it,” explains Doctor Fournier.

Gaétan himself described the experience: “There, I’m fine, I feel decent, I was able to find the words… I feel that my brain is open.”

Maintaining Patient Safety

Throughout the procedure, the surgical team remained prepared to return the patient to deep general anesthesia if necessary. They were equipped to manage potential complications such as bleeding or epileptic seizures. “We can also return to deep general anesthesia at any time. We are ready for complications such as bleeding or epileptic seizures for example,” underlines Doctor Sina Grape, specialist in anesthesiology.

Successful Outcome and a New Outlook

The surgery was deemed a success, with no major speech problems reported. While some minor language difficulties, such as word-finding pauses (paraphasias), were present, the neurosurgeon anticipates these will improve with rehabilitation.

“We achieved exactly what we wanted without any major speech problems,” the neurosurgeon stated. “There are still some paraphasias. We see that there are searches for the word, but it is something that will be able to be recovered with rehabilitation.”

Gaétan expressed a renewed appreciation for life following the ordeal. “If I hadn’t gone through that, I reckon, I wouldn’t have made it long. There, frankly, I love everyone, I only see the good things. I’m at the top! I’m going to slow down. I was doing way too much.”