Will I feel pain during awake brain surgery?

No — awake brain surgery is not painful. The brain itself has no pain receptors, so once the scalp and skull are opened under sedation and local anaesthetic, removing the tumour does not hurt. You are gently woken only for the mapping part, and a scalp nerve block keeps the incision area numb. Most patients describe the experience as strange but comfortable, not agonising. An anaesthetist stays beside you the whole time, ready to deepen sedation if you feel anxious. After the mapping is complete, you are sedated again for the skull to be closed.

Why would a tumour need awake craniotomy instead of standard surgery?

An awake craniotomy is chosen when a tumour sits in or next to eloquent brain — the areas that control speech, language, or movement. In these locations, the surgeon cannot tell from the scan alone exactly where the function lives, because it varies slightly from person to person. By keeping you awake and asking you to talk or move during surgery, the team maps these areas in real time and works right up to their edge. This allows safe removal of more tumour while protecting the abilities that matter most to daily life. For tumours far from these areas, a standard craniotomy under general anaesthesia is usually enough.

What does brain mapping during an awake craniotomy involve?

During the awake phase, the surgeon touches the exposed brain surface with a small electrical probe while you perform tasks — naming pictures, counting, reading, or moving a hand or foot. If stimulating a spot briefly disrupts your speech or movement, that area is marked as essential and protected. This is called intra-operative cortical and subcortical mapping. It is often planned in advance with a functional MRI and brain mapping scan, which shows the likely location of speech and movement before the operation even begins, helping the team plan the safest route to the tumour.

Does CION perform awake craniotomy in-house?

CION does not have an in-house neurosurgeon, so the surgery itself is coordinated with our accredited neurosurgical partners who are experienced in awake mapping. What CION provides directly is the surrounding cancer care that determines the outcome: a multidisciplinary tumour board to confirm surgery is the right step, molecular testing on the tumour sample, radiation therapy and systemic (medical) therapy after surgery, steroid and seizure control, imaging, and rehabilitation support. We make sure surgery, pathology, radiation, and medical oncology work as one plan rather than disconnected steps.

How long does recovery take after an awake craniotomy?

Most patients are awake, talking, and moving within hours of an awake craniotomy, and many go home within two to four days if there are no complications. Because the surgery is designed to protect speech and movement, deficits are usually temporary when they occur — often improving over days to weeks with rehabilitation. A short course of steroids reduces brain swelling, and you will have a follow-up MRI to confirm how much tumour was removed. The full recovery and return-to-work timeline depends on the tumour type and what treatment follows, which your CION team will map out for you.

What treatment usually follows an awake craniotomy?

Surgery is the first step, not the whole plan. The tumour removed is sent for histology and molecular testing (markers such as IDH, MGMT, and 1p/19q), which guides what comes next. For higher-grade tumours, this typically means radiation therapy (IMRT/IGRT) and systemic therapy such as alkylating chemotherapy — both delivered directly at CION. The exact combination is decided by the tumour board. You can read more about the complete pathway on our brain tumour treatment in Hyderabad page.