Most people use social media to show pictures or videos of themselves, their family or their friends doing activities. Live-streaming involves simultaneously recording and broadcasting media online in real-time. It is becoming more popular and statistics indicate 42% of the US population have live-streamed online content at some point. Nearly 44% say they watch less live TV due to live-streaming. Live-streaming is going to be a predicted $70.5 billion industry by 2021.
On October 29, 2019, a woman in Texas live-streamed her awake craniotomy for resection of an arteriovenous malformation (AVM). Tens of thousands of people reportedly tuned in to her surgery at Methodist Dallas Medical Center.
In certain cases, a tumor or vascular malformation may reside in a primary control center for movement, sensation or speech. These are called “eloquent areas”. When this occurs, it may be safer for the patient to be awake during surgery so their brain areas can be stimulated to monitor function and its preservation.
When we discuss with the patient that they may be awake during surgery, most people have trepidation. It sounds scary, uncomfortable or painful. In reality, patients handle the procedure extremely well. The skin, bone, and coverings of the brain have pain receptors, but all these areas can be anesthetized so traversing them is usually painless. The brain itself has absolutely no pain receptors and can be manipulated and dissected without any discomfort. When we perform awake craniotomies, we tend to have the patient listen to the music of their choice during surgery and have conversations to keep them calm and safe. Many patients feel relief when we are finished and they can see they have preserved function. Awake craniotomy also avoids some of the side effects of “general anesthesia” which can cause some patients to be confused, lethargic or nauseous following surgery.
Spine surgery, in some indications, may also be performed semi-awake.
Most brain surgeries do not require an awake craniotomy, however, if it is needed, patients often tolerate it well. That being said, we are not big proponents of live-streaming a surgery of any kind.