What If You Wake Up During Brain Surgery? | Unveiled

What If You Wake Up During Brain Surgery?

As the anaesthetic takes hold, you begin to feel sleepy… someone counts down from ten, your eyes slowly close, and then you’re out. Those are your last memories before going into surgery, until coming round in a recovery ward a few hours later… or, at least, that’s how it should be! But there have been instances where things haven’t gone to plan.

This is Unveiled, and today we’re answering the extraordinary question; what if you wake up during brain surgery?

First things first, brain surgery is a vitally important field in modern medicine. And today’s brain surgeons are literal life savers. Doctors have an ever-increasing understanding of how the brain works, and surgery can be crucial in treating conditions like blood clots, tumours and aneurysms… all of which, without treatment, can be fatal. We’ve also seen in more recent times how brain surgical procedures can be used to help fight neurological conditions, including Parkinson’s disease. And the predictions are that, in the future, we’ll be able to tackle many more medical ailments by directly operating on the brain. A brain surgery is never without risk, and doctors should always highlight these risks as best they can… but success and recovery rates are also extremely high in some cases. And horror stories are rare.

That said, they’re not unheard of. The American Society of Anaesthesiologists estimates that in about one in every 1,000 operations requiring general anaesthesia… a patient might report some level of awareness mid-surgery. That’s for all surgeries, on all parts of the body. According to the ASA website, however, “although it can be upsetting, patients usually do not feel pain”. So, that’s something! What’s important for today’s question, too, is that the ASA doesn’t list brain surgery as a procedure that’s particularly prone to this scenario - instead saying that you’re most likely to wake up during specific heart and trauma surgeries. And even then, remember, it is still very rare.

Perhaps what makes the prospect of waking during an operation so frightening, though, is that those who report having done so often also report total paralysis. In fact, a 2014 study, carried out by the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland, found that paralysis came out as a leading reason for distress among those who had experienced accidental awareness during surgery. In this situation, patients recall knowing that they were awake… but being totally unable to raise the alarm with the surgeons working around them. And so, the hospital staff don’t realise the ordeal that their patient is going through.

This faintly terrifying aspect of modern medicine does link directly to brain surgery, too, because paralysis drugs are often used to prevent any random, spontaneous movement while your brain is under the knife. With the brain, as with many major organs, one false move could be the difference between life and death… so it’s crucial that the patient remains still. But, if you were to ever wake up while your brain was being worked on, it means that you could feel hopelessly trapped. Forced into a disturbing experience, with no way of escaping it. And, while it’s a slight relief that most medical authorities report that surgery awareness should only last for a matter of seconds (if it happens at all), it’s also no surprise that many who do suffer it require post-traumatic stress counselling afterwards.

And yet, there's a good argument that if you’re gonna wake up during a surgery, then a brain surgery might not be such a bad one to do so in. Sure, it sounds like the stuff of nightmares… but the thing is that, to some degree, the brain doesn’t feel pain. It may be the central processing system for pain in the body… but it doesn’t actually have pain receptors itself, otherwise known as nociceptors. The general, kinda gruesome idea is that if your brain were to be exposed, then somebody could prod and touch it and you wouldn’t automatically realise what they were doing. In this way, wake during brain surgery and you could be totally numb to what was happening to you. One other relative upside is that while there’s the alarming possibility with other surgeries of seeing your own operation take place, with brain surgery you wouldn’t see much of anything at all, if you woke up in the middle of it. Our own brains are obviously outside of our field of vision, so all the gory stuff would be happening as though behind you.

Which brings us to the amazing images that often make news headlines around the world, where a brain surgery patient is purposefully kept awake during their procedure. In February 2020, for example, footage was released of the violinist Dagmar Turner playing her violin while surgeons at King’s College Hospital in London operated to remove a tumour from the right frontal lobe of her brain. The procedure is called an awake craniotomy, and it’s actually carried out with safety in mind first and foremost.

In Turner’s case, the tumour being removed was located particularly close to the area of the brain responsible for left-hand movement… an area therefore essential for playing the violin. But, by operating whilst their patient was awake, and specifically whilst they were playing music, doctors were able to ensure that nothing they did to Turner’s brain was having an adverse effect. She played the violin throughout the surgery, and post-surgery (once the tumour had been taken out) she could still play just as well as ever.

Of course, a patient undergoing an awake craniotomy is still put under anaesthetic for some parts of it - namely the beginning and the end, when pieces of bone are surgically removed from their skull or fixed back into place. These incredible operations allow surgeons to keep a careful eye on other things too, however, including how a patient speaks and whether or not they become confused. It’s all about preventing and limiting unnecessary upheaval in this, the most important organ in your body.

Still, for many it’s incredible to think that you could be chatting away with your doctor whilst they literally have your brain in their hands! And it’s true that an awake craniotomy isn’t for everyone. If a patient suffers from an anxiety disorder, for example, then surgeons are less likely to put them forward for the procedure. Again, it’s vitally important that even somebody who’s awake remains as still as possible during surgery. That they only do what the surgeon asks of them. But this is a situation that can understandably provoke panic and distress… so everyone around the operating table is trained to spot this at the earliest possible moment. In Dagmar Turner’s case, she was able to remain calm throughout… which was a major reason why her operation was a success. And, in fact, it was her idea all along! It was so vital to her that she retained her skill with the violin that she reportedly suggested awake surgery to her doctors, after seeing a video about it on YouTube!

So, with all this in mind, what does the future of brain surgery look like? Well, it’s still much more likely that if you ever did need a brain operation, you’d be put under anaesthetic for it. And, in all probability you’d stay under for the duration! Accidental awareness does happen, but it’s thankfully rare. As for deliberate awareness, though, it’s not as though awake craniotomies are going to fade out of practice anytime soon. In science and medicine, they provide a unique insight into how the most complex part of our body functions… and they can often be the best way to treat a problem.

In other brain news… in July 2019, a team of scientists successfully mapped every neuron in the brain of a small worm, marking the first time this had been done for any species. Naturally, we’re now looking to the future and imagining a time when we can do this for the human brain. The Human Connectome Project is probably the single-biggest academic effort to make it happen… but however we get there, scientists predict that our knowledge of the brain is going to rapidly grow in the next few decades. By which time, the whole idea of waking up during brain surgery might not be such an incredible (or uncomfortable) thing to think about anymore…

Throughout history we’ve seen how medicine has moved forwards, and improved. And today there are any number of surgical practices that might have once been dangerous, or daunting, but are now commonplace. Perhaps awake craniotomies will eventually become one of those? But, until then, that’s what would happen if you woke up during brain surgery.