Patient and Neurosurgeon Discuss Awake Craniotomies

During an awake craniotomy, patients are conscious and communicating with surgeons who are working to remove cancerous cells and tumors from their brain. It’s a procedure that is performed at Moffitt Cancer Center by Dr. Arnold Etame, neurosurgeon and neuro-oncologist in the Neuro-Oncology Program.

Recently, Etame and his patient Abby Baker spoke during a special Ask the Experts Facebook Live event to discuss the procedure and to relay what the experience is like from a patient’s perspective.

Baker underwent two awake craniotomies, one in 2017 and another in 2019, after her neurologist discovered a large tumor in her frontal lobe.

Since the last surgery, Baker has remained cancer free and is now focused on helping others. She spends her free time meditating, practicing yoga and attending church services.

Check out highlights from the discussion with Etame and Baker:

What is an awake craniotomy?

Dr. Arnold Etame: The awake craniotomy refers to a procedure where during the removal of the brain tumor, the patient is awake. That’s so the patient can be tested as the tumor is removed. It’s usually used for the most part for tumors that are close to areas of language and movement.

Because the brain has no sensation when you remove tissue, patients do not really have any perception of pain. Patients can be comfortable during this operation, but they do get a little bit of anesthesia.

As a patient, what do you recall from the two awake craniotomies you experienced?

Abby Baker: The first surgery (in 2017), I don’t really recall it. I remember it being about several hours and it was intense in the aftermath. The second surgery (in 2019), that one I was definitely pretty alert and to this day I can still recall it.

After the second surgery I got in even deeper with where I am spiritually and for me my passion is truly through meditation and yoga.

I did have some speech issues and I got assistance there. I learned that I could practice with somebody else but as soon as I stopped talking, I would lose a word here and there. It was a lot of working on my own at home to relearn how to form those words.

What type of communication is necessary during an awake craniotomy?

Etame: We generally make sure they are comfortable and learn where their stress levels lie. We ask general questions about their lives to make sure things are OK and we may ask patients to perform tasks, like count or name things. These surgeries often work close to movement-related areas so we can do basic language testing and movement tasks. We test the extremities like the legs.

What were some of your symptoms that lead to this diagnosis?

Baker: I started seeing what I considered auras and I was having déjà vu moments at the end of 2015. Every time I would start to exercise, I was getting them. I kept going to the doctor to figure out if I had brain cancer or something else.

Given the fact that I had children, I was originally told it was just stress, but when I finally saw a neurologist in early 2017, I got an MRI that showed I had a 5.7 centimeter tumor in the left temporal lobe. After consultations I found my way to Moffitt and met Dr. Etame, who explained the awake craniotomy.

What does treatment look like after a procedure like this?

Etame: It really depends on the tumor pathology. Chemotherapy in the form of a pill called Temozolomide is tolerated well by patients like Abby and they don’t get as sick as when they are administered chemotherapy through an IV. Some patients continue chemotherapy and radiation therapy anywhere from six months up to a year after the procedure.

Then there are MRIs frequently and if anything is found, surgery can be done safely to remove that resistant population of tumor cells.

You are healthy and independent now after two awake craniotomies. Where are you now on your cancer journey?

Baker: I now have MRIs every five or six months. Before I was getting them consistently every three to four months. This experience changed everything for me and I’m doing everything day by day.

In fact, I have one scheduled in the next two weeks, so I’ll be getting my little update there.