When a brain tumor caused issues with movement and uncontrolled epilepsy in a teenage patient, neurosurgeon Dr. Jason Hauptman performed Phoenix Children’s first ever Awake Craniotomy. This advanced technique allowed the surgical team to precisely map and protect critical areas of the brain, while carefully excising the tumor and receiving real-time feedback. Watch as Dr. Hauptman performs this procedure and discusses how it enables surgeons to operate more precisely and safely.
My name is Jason Houtman. I'm a pediatric neurosurgeon. I'm the chief of neurosurgery here at Phoenix Children's Hospital. Aiden has what looks like a benign brain tumor, and it's causing both problems with movement, but it's also causing epilepsy, and that epilepsy is really disruptive to his life. So our goal today is going to be to remove this tumor carefully while doing everything we can to spare the function of that primary motor cortex. This is the front end of it. Because he's going to be awake, the only part of the body that senses any pain at all is the skin. So this surface anesthetic is actually probably the biggest component of anesthesia that we can provide to provide comfort during the awake component. Everything we do in neurosurgery is not a one person operation. It relies on a group of very talented people all committed to a singular goal, which is a safe and effective surgery for your child. At the beginning of the surgery, we make an incision that allows us to make a window in the skull bone so that we can access the brain region in which we need to operate. At that point we start waking the child up. Uh, let me know when Aidan's starting to open his eyes. Now our anesthesiology team here at Phoenix Children's consists of incredibly talented, very experienced anesthesia professionals. Aidan, can you hear me? It's Jason Hauptman. Are you able to say hi? Uh, I got some scraping from my nap. Great, perfect. All right, this is a good time to do some stem finding. At that point in time we use electrical stimulation using a very, very, very fine tipped instrument. By stimulating the brain surface, we can actually test the brain surface for function. OK. Here you're looking at the 1st 3 electrodes, yeah, yeah, so, but that's very striking. Yeah, yeah, that's right over the lesion. You're just waking up, Aidan, you're doing great, man. You are doing great. We are getting all the information that we need. OK, you know what? I actually am good with mapping. I, I am. I, I know exactly where everything is. We can go ahead and, and put him to sleep if you want. Thank you. That was a really great mapping, guys. Thank you very much. So what we've done at this point in the surgery is with Doctor Kerrigan and his team's help we've looked at the surface of the brain to see where we think the seizures might be coming from. We found an area very irritated that exactly overlaps the area of abnormality on his MRI. Then with the fantastic. Work of our anesthesia team. We're able to effectively wake him up and test him for movement. We're able to find out where on the brain surface the brain communicates with the muscles. So this is about the extent of our mapping and at this point we're going to remove this lesion and that way we can get an answer as to what it is and hopefully cure him of his epilepsy. I thought surgery went great today. Our colleagues in anesthesia did a fantastic job keeping him comfortable, waking him up for the mapping and keeping him comfortable for the mapping, and then putting him back to sleep for the remainder of the operation. I call this a successful awake craniotomy because we were able to ideally identify the area of the brain surface responsible for movement on the other side of the body, and by doing that it allowed us to do the safest operation we possibly could for him.
