Awake craniotomy overview

These pages were written to provide awake craniotomy information for non-clinicians. A position paper and resources designed for SLTs working in this area can be accessed in the Clinical Guidance portion of our website

Last updated:  October 2025

What is awake craniotomy?

Awake craniotomy 

In the UK, over 12,000 people are diagnosed with a primary brain tumour each year (The Brain Tumour Charity, 2025). 

Awake craniotomy, also known as awake brain surgery, has become the gold standard and common practice for the removal of brain tumours close to, or within, areas of the brain used for language and speaking. The aim of awake craniotomy is to monitor and preserve a patient’s speech and language function, while safely removing the tumour.  

This is achieved through the patient being awake for all, or part, of the surgery. The patient should not feel pain as the brain does not have pain receptors. An anaesthetist will be present throughout the surgery to ensure the patient is comfortable and pain-free at all times.  

Brain mapping  

The process of ‘brain mapping’ involves a neurosurgeon applying pain-free, electrical stimulation to different areas of the brain, whilst a speech and language therapist assesses the patient’s speech and language function. If the patient’s speech or language skills are disrupted during the stimulation, the speech and language therapist will inform the neurosurgeon immediately. This will help the neurosurgeon to locate areas of the brain which are important for speech and language function and should therefore not be disturbed. 

Patients should not be alarmed by the temporary disruption to speech and language function, as the stimulation effects wear off within five seconds. 

How can speech and language therapy help? 

SLTs are experts in speech, language and communication and have an in-depth knowledge of the speech and language network in the brain. They are part of a specialist multi-disciplinary team and work collaboratively with neurosurgeons to provide high quality care. 

SLTs will work closely with patients before, during and after their awake craniotomy.  

Speech and language therapy before surgery 

Before the operation, a speech and language therapist (SLT) will complete a comprehensive pre-operative assessment. This will include: 

  • providing patients and their family/friends education on the process of awake craniotomy, including brain mapping and language testing and the role of SLT during and after the operation
  • completing a comprehensive case history
  • practice of the language tasks which will be done during the surgery
  • carry out an assessment of the patient’s overall speech, language and communication skills
  • rapport building and understanding the patient’s interests to enable individualised assessment and conversation during the surgery 
  • answering any questions patients or family/friends may have.

Speech and language therapy during surgery 

During the operation, an SLT will:  

  • continuously provide the patient with guidance and reassurance
  • help determine when patients are ready to start speech and language testing after being woken
  • carry out a range of targeted speech and language assessments during brain mapping and tumour removal. These may include assessments such as naming a picture or repeating words or sentences
  • identify, interpret and communicate any temporary changes to the patient’s speech or language skills to the neurosurgeon
  • monitor patient speech and language skills through dynamic conversation.

Speech and language therapy after surgery 

The same SLT will see patients after their surgery. All patients should receive a comprehensive assessment of their speech, language and communication skills in the day(s) following their operation. 

Many patients will not experience changes to their communication. Some may experience temporary difficulties, which should resolve in the days, weeks or months after the operation. For other patients, some difficulties may persist.  

For those experiencing changes to their communication, a speech and language therapist can offer: 

  • education, advice and strategies to patients and friends/family to enhance successful communication and alleviate frustration
  • individualised and targeted therapy interventions
  • alternative methods of communication – see AAC section for more details
  • referral to outpatient or community speech and language therapy services, or inpatient neurological rehabilitation
  • signpost to charities and support networks 

Multilingual patients

Multilingual patients, or those who do not speak English, should be offered language testing before, during and after awake craniotomy, in their preferred language(s). Speech and language therapists will work closely with qualified interpreters to ensure optimal translation of all resources and patient responses. 

Speech and language therapists are dedicated to providing patient-centred and bespoke care. As such, they will work closely with the patient, their family/friends and the interpreter to ensure all testing materials used are culturally appropriate and relevant.  

For further information, please read RCSLT bilingualism information. 

Resources

Key charities and organisations 

RCSLT resources 

Other resources  

A patient information video has been created by the MDT at University Hospitals Birmingham NHS Trust.  

This video is approximately 15 minutes and follows a patient journey through the pre, intra and post operative phases and demonstrated the key roles of MDT members.