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Awake Craniotomy

Washington DC Brain Mapping

To prepare for surgeries that target brain tumors or epilepsy, or for placement of devices such as a deep brain stimulation (DBS) implant, “awake” craniotomy is performed to determine which areas in the patient's brain are responsible for certain functions. In this procedure, surgeons electrically stimulate regions of the brain while the patient is awake, to create a map of areas that should be avoided during surgery, such as areas that govern speech and movement. This is a painless, but major, open brain surgery which can lead to excellent outcomes by preserving critical brain functions.

Most right-handed people are “left-brained,” meaning that speech and the understanding of words resides in the left hemisphere of the brain. The right hemisphere is most often associated with the ability to visualize in three dimensions, musical sense, and emotional response. While it is important to spare as much normal function as possible in any brain procedure, language is considered a very critical function, and thus much attention is paid to this ability when planning brain surgery. Movement is the other critical function, also controlled by very specific areas in both hemispheres- the left hemisphere controls the right side of the body, and vice versa.

No Anesthesia Necessary

Because the brain itself does not sense pain directly, an awake craniotomy can be performed while the patient is under local anesthesia. Awake craniotomy is major brain surgery that requires temporary removal of a portion of the skull to allow the surgeon access to the outer portion of the brain, or cerebral cortex.

Because he or she is conscious during the procedure, the patient can report sensations in response to stimulation of specific brain areas. Sensations can be as specific as seeing an image (in response to stimulation of the visual cortex), to a feeling of déjà vu, to the movement of an arm or leg. These verbal reports and physical clues allow the surgeon to carefully plot a three-dimensional map of the brain and to pinpoint areas of disease or injury. Subsequent surgery can then minimize any damage to the brain that might compromise normal function.

Clinical Trials

  • WIZARD: A Randomized, Multicenter, Phase 2 Study of DSP-7888 Dosing Emulsion in Combination with Bevacizumab versus Bevacizumab Alone in Patients with Recurrent or Progressive Glioblastoma following Initial Therapy

    This is a randomized, active-controlled, multicenter, open-label, parallel groups, Phase 2 study of DSP-7888 Dosing Emulsion plus Bevacizumab versus Bevacizumab alone in patients with recurrent or progressive glioblastoma multiforme (GBM) following treatment with first line therapy consisting of surgery and radiation with or without chemotherapy. One of the primary outcome measures is to assess the effect of DSP-7888 Dosing Emulsion plus Bevacizumab versus Bevacizumab alone on the Overall Survival of patients with recurrent or progressive GBM following treatment with first line therapy consisting of surgery and radiation with or without chemotherapy.Overall survival is defined as the interval between randomization and death from any cause

  • A Double-Blind, Placebo-Controlled, Inpatient, Dose-Ranging Efficacy Study of Staccato Alprazolam (STAP-001) in Subjects with Epilepsy with a Predictable Seizure Pattern

    This is a multi-center, double-blind, randomized, parallel group, dose-ranging study to investigate the efficacy and clinical usability of STAP-001 in adult (18 years of age and older) subjects with epilepsy with a predictable seizure pattern. These subjects have an established diagnosis of focal or generalized epilepsy with a documented history of predictable seizure episodes. This is an in-patient study. The subjects will be admitted to a Clinical Research Unit (CRU) or Epilepsy Monitoring Unit (EMU) for study participation. The duration of the stay in the in-patient unit will be 2-8 days. One seizure event per subject will be treated with study medication. The duration and timing of the seizure event and occurrence of subsequent seizures will be assessed by the Staff Caregiver(s)1 through clinical observation and confirmed with video electroencephalogram (EEG).

  • Malignant Brain Tumors
    A Multicenter Study of 5-Aminolevulinic Acid (5-ALA) to Enhance Visualization of Malignant Tumor in Patients with Newly Diagnosed or Recurrent Malignant Gliomas: A Safety, Histopathology, and Correlative Biomarker Study This single arm trial is being conducted to establish the safety and efficacy of Gliolan® (5-ALA) in patients undergoing resection of newly diagnosed or recurrent malignant gliomas. The rationale for the study is that Gliolan® (5-ALA), as an adjunct to tumor resection, is safe and will provide surgeons with real-time visualization of malignant tumor.