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Awake craniotomy


Thinking ahead for patients in need of a complex brain surgery

Penny Liu, MD is the Director of Neurosurgical Anesthesia at Tufts Medical CenterAn awake craniotomy, or brain surgery while the patient is awake, is not your everyday procedure. That is, unless you are Penny Liu, MD, the Director of Neurosurgical Anesthesia at Tufts Medical Center. Dr. Liu works in a pre-operation clinic that prepares patients for their awake craniotomy.

Awake craniotomies are typically used to treat patients who have a lesion or brain tumor that has spread to what is said to be the “eloquent” areas of the brain, meaning that it is in a part of the brain that may affect speech, movement, or cognizance. 

Having the patient awake is the best way to monitor progress, says Dr. Liu. “We want them to be able to talk to us so that if they suddenly stop talking, have slurred speech, or can’t name an everyday object, we know we are in a dangerous area.”

A step-by-step guide before the surgery

Tufts Medical Center thinks ahead for patients by scheduling them to see Dr. Liu before their surgery. During the appointment Dr. Liu describes the surgery and what to expect. “I want the patient to know exactly who is going to be working with them,” she said. “I want all of those anxieties gone before the day of the surgery.” 

Dr. Liu is straightforward with her patients and describes each step of the surgery in detail. “I want to be very honest with patients. I need them to have the proper understanding of the surgery so that nothing comes up in the operating room that could prevent us from finishing,” explains Dr. Liu. Patients know what pictures they will be shown, what questions they will be asked, and most importantly, are familiarized with everybody that will be in the room with them. 

“We are the only people a patient will see during surgery” said Dr. Liu of herself and her colleagues. “They may hear their surgeon’s voice from behind them, but they see our faces the whole time. We get comfortable with each other.” Dr. Liu says that she has seen this practice truly pay off with her patients. If a patient is comfortable with their doctors ahead of time, they are more comfortable during the procedure. 

The art of caring for patients before, during and after surgery

The continuity of care that these patients feel is critical to this process, according to Dr. Liu. “We are not a part of that case unless we are there for the very first step,” she said. This includes, doctors, surgeons, and even anesthesiologists. “Sometimes, caring for patients is art,” said Dr. Liu. “The way you care for them, the way you treat them, this is entirely critical for our surgeries to be successful.” 

See other examples of how Tufts MC is Always Thinking Ahead