Patients Awake During Neurosurgery? : The Awake Craniotomy and the Role of the Patient as Innovative 20th Century Surgery

An awake craniotomy is a type of brain surgery that is performed on patients who are conscious during the operation. This article will focus on the history of the development of the awake craniotomy and the importance of the patient’s role during the operation. Going back to ancient history, archaeological records demonstrated that trepanation of the skull occurred thousands of years ago, before the discovery of general anesthesia. Moving on to the modern awake craniotomy, Dr. Wilder Penfield, the American-Canadian neurosurgeon, sparked the modern era of awake craniotomies through his work in neural stimulation during the 1920s to 60s. During the Montreal Procedure, Dr. Penfield interacted with his patient’s during surgery using only local anesthetic. By probing specific parts of the brain, patients were able to provide Dr. Penfield with immediate feedback. Dr. Penfield stated that his patients were fellow explorers of the unknown brain and together they built the maps which he is famous for. Dr. Penfield’s patients were not just important during the operation, they had an important role afterwards. Patients’ self reports were vital, and Dr. Penfield was the one who interpreted the answers from them. The modern era of the awake craniotomy was established almost 70 years ago, and it revolutionized the field of neurosurgery. Today, awake craniotomies continue to demonstrate the importance of the patient’s role in their own care and help us further understand the complexities of the brain