Awake Craniotomy with the Lexington Medical Center Brain Tumor Program

Inside an operating room at Lexington Medical Center, Karen Adkins had surgery to remove a tumor from her brain – while she was wide awake.

As Johnathan A. Engh, MD, FAANS, of the Lexington Medical Center Brain Tumor Program worked to remove the astrocytoma invading the supportive tissue of her frontal lobe, Karen kept up a lively conversation with one of the nurses in the surgical suite.

Karen Adkins kayaking on Lake Murray

“She asked me about my brothers and sister, where I grew up and what street I lived on,” Karen said. “She asked me to blink, move my face and stick out my tongue. We also talked about how we were both redheads.”

The procedure Karen was having is called an awake craniotomy, a type of surgery where a piece of the skull is temporarily removed to access the brain and then the patient is woken up during surgery.

When a tumor is near a part of the brain that controls critical functions such as speech, language or movement, an awake craniotomy is beneficial.

“While being kept comfortable, the patient can talk, move an extremity of interest, or name objects on a screen,” Dr. Engh said. “It allows the neurosurgeon to track the patient’s motor function and speech in real time during the operation.”

That helps doctors avoid hitting nerves that control key functions. The frontal lobe – where Karen’s tumor was located – controls speech and motor function. Damaging those nerves could lead to permanent disability.

Dr. Johnathan Engh

“Awake craniotomy allows us to work in functional regions of the brain while keeping track of the patient’s neurologic state. As a result, we can remove brain tumors that would otherwise not be safely removable,” he said.

And because brain tissue does not have pain fibers, patients don’t feel pain as doctors remove the tumor.

Awake craniotomy is one of the many surgeries performed in the Lexington Medical Center Brain Tumor Program. It’s something Karen needed after being diagnosed with a brain tumor in the summer of 2019.

The Diagnosis
Karen was a 49-year-old Irmo wife and mom who had just retired from a career in vocational rehabilitation. She enjoyed spending time kayaking on Lake Murray.

Karen had no idea a tumor was growing inside her brain until she suffered a seizure one night at home. Her husband Lee described what he saw.

“Her eyes were wide open. She was on her back and very limp,” he said. “That was extremely scary.”

Tests at Lexington Medical Center revealed a low-grade astrocytoma, a type of tumor that begins in cells called astrocytes that support nerve cells. Symptoms can include seizures, nausea and headaches.

“With a low-grade tumor, it’s very common for patients to suffer a seizure, but no other symptoms,” said Dr. Engh. “The brain is a complex circuit with billions of nerves that transmit signals to each other at different times. If something disrupts those connections – such as a fever, infection, or tumor – a seizure can occur.”

Dr. Engh was confident he could remove the whole tumor with an awake craniotomy.

“After Karen’s surgery, an MRI revealed the entire tumor was gone,” Dr. Engh said.

Brain Tumor Program
“The human brain is driven by trillions of electrical currents transmitted from specific areas to others at set times in order to create consciousness,” Dr. Engh said. “It’s estimated that the brain contains 100 billion neurons, cells that make up the electrical wires of the circuit. The number of connections between these wires is even greater.”

Despite this incredible complexity, the symptoms of brain tumors are often vague and non-specific. They include headache, confusion, weakness, changes in personality and seizures.

“With a multi-disciplinary team at Lexington Medical Center, the level of expertise and specialty is there for everything we need to do and to have all the pieces in place,” Dr. Engh said.

In fact, Dr. Engh has patients travel from around the country for him to operate on them at Lexington Medical Center. Patients have come from as far away as Washington.

Life After Brain Surgery
Karen has a new perspective after having a brain tumor.

“The three best days of my life were the day I got married, the day I had my son and the day I came out of brain surgery with Dr. Engh,” she said.

These days, Karen has routine visits with Dr. Engh to make sure her tumor is not trying to come back.

“Patient cooperation and commitment to care is so important,” said Dr. Engh. “Be willing to go to your doctor and have the appropriate scans and follow up.”

And she appreciates things more. She’s back in her kayak on Lake Murray, which Dr. Engh says is good medicine.

“The patients who do the best are the ones trying to live their lives to the fullest.”

U.S. Army Black Daggers Parachute to Lexington Medical Center

The United States Army Black Daggers – Special Operations Command Parachute Demonstration Team – jumped onto the campus of Lexington Medical Center in West Columbia today. The event was part of the Army’s Salute to Healthcare Workers during the COVID-19 pandemic. Hundreds of hospital employees and community members were on hand to watch the patriotic display.

The Black Daggers are volunteers from throughout the Army’s special operations community with diverse backgrounds and military specialties. The team performs parachuting demonstrations around the country as part of community outreach and recruiting efforts. They have jumped onto hospital campuses this year to thank medical professionals for their efforts taking care of COVID-19 patients.

The Black Daggers jump from an airplane at an altitude of up to 8,000 feet and free fall for about two minutes at approximately 120 miles per hour. They maneuver their bodies using their hands, arms, legs and shoulders to control their flight and land in a targeted location.

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To learn more about the Black Daggers, click here.

Advanced Brain Surgery Techniques Improve Outcomes

By Jonathan A. Engh, MD
Lexington Medical Center Brain Tumor Program

Brain surgery is essential, and even life-saving, to the care of many patients with brain tumors or other brain conditions. However, it is not without substantial risk. One of the central principles of medicine is “primum non nocere,” or “first do no harm.” It’s a reminder that our interventions for disease may cause injury to a patient, and that we must avoid injury whenever possible.

Few interventions in medicine are more potentially dangerous than brain surgery. Stroke, hemorrhage and infection are just a few of the potentially devastating complications that can harm a patient or even lead to death. At Lexington Medical Center, we utilize on specialized techniques, not widely used at most medical centers, to reduce the risk of brain injury from tumor surgery.

Awake craniotomy is a specialized method of brain tumor surgery in which the patient remains awake and alert during surgery. While being kept comfortable, the patient can talk, move an extremity of interest, or name objects on a screen. This allows the neurosurgeon to track patient’s motor function and speech in real time during the operation.

It is critical that the entire operating room team be specially trained in this technique in order for it to be successful. Otherwise, the patient can be more prone to problems like breathing complications or seizures in the operating room. Lexington Medical Center has a dedicated team that specializes in awake craniotomy for brain tumors. Using this technique allows us to work in functional regions of the brain while keeping track of the patient’s neurologic state. As a result, we can remove brain tumors that would otherwise not be safely removable.

Minimally invasive port surgery is another specialized technique utilized to prevent injury in the operating room at Lexington Medical Center. Using a small, cylinder-shaped retractor, the neurosurgeon can access deep brain regions with less disruption to the surrounding brain tissue. With this technique, patients with deep brain tumors and tumors in the fluid system of the brain (intraventricular tumors) can have successful surgery and achieve relief of their symptoms while minimizing the risk of being injured during their operation.

To learn more about the Lexington Medical Center Brain Tumor Program, visit