An awake craniotomy with intraoperative monitoring is a specialized neurosurgical procedure in which the patient remains awake and responsive during part of the surgery. This technique is typically used for surgeries involving brain areas associated with critical functions such as speech, motor skills, or sensory processing. By keeping the patient awake, the surgical team can actively monitor the patient's neurological function in real time, allowing them to avoid damaging vital areas of the brain.

During the procedure, the patient is given local anesthesia to numb the scalp and skull while being kept awake and alert. Sedation may be provided during certain parts of the surgery when the brain is not being directly manipulated. Throughout the surgery, the patient may be asked to perform specific tasks such as speaking, moving limbs, or responding to questions. This helps the surgical team map and identify functional areas of the brain and ensure that the surgery does not impair these essential functions.

Intraoperative monitoring is a crucial part of the procedure, involving the use of various techniques to assess the patient's neurological function. For example, cortical and subcortical mapping using electrical stimulation can help identify areas of the brain responsible for speech, movement, or sensation. Continuous monitoring of the patient's vital signs and neurological status provides immediate feedback to the surgical team, allowing them to make real-time adjustments to their approach.