Neuro-Oncology
This area of the website is for patients who might need, or have had surgery for Brain tumours.
For more information and support about brain tumours, please visit The Brain Tumour Charity website.
There is more local support available at Yorkshire’s Brain Tumour Charity.
Awake Craniotomy
We have created this video to show an example of a patient’s journey through Awake Craniotomy surgery. It features a range of the health professionals who may support you.
Allied Health Professionals in the Awake Craniotomy Patient Pathway
Hello, my name is Ellie Stevenson, and I am a neuro-oncology physiotherapist at Leeds General Infirmary. In this video, we aim to highlight the role of Allied Health Professionals (AHPs) in the awake craniotomy pathway. This is a complex neurosurgical procedure where brain tumors located in or near eloquent areas of the brain—regions critical for function—are resected or biopsied while the patient is awake. This allows us to test movement, sensation, speech, vision, and cognitive function in real time during the surgery.
AHPs play an integral role throughout this pathway, involved at every stage of the patient’s journey: before, during, and after the surgery. AHPs have been part of this process since the pathway’s creation over 12 years ago, and Leeds is now a national leader in awake craniotomies.
As a speech and language therapist in the low-grade awake craniotomy service, my primary role is to assess patients’ language before, during, and after surgery, helping them manage any deficits. I am also there to advocate for patients, explaining the process and supporting them through their anxieties, both prior to and during the procedure. My team, including neuropsychologists, works with patients diagnosed with low-grade gliomas who are scheduled for awake surgery, typically shortly after diagnosis.
We have two main goals in pre-operative assessments: first, to assess the patient’s cognitive function, and second, to evaluate their emotional state. This helps ensure they can manage the awake procedure safely, and identify any support they might need before surgery. Post-surgery, we follow up with patients to check for any cognitive changes and provide necessary rehabilitation, including emotional support throughout the pathway.
Visual function and visual fields are also monitored during the surgery. Our goal is to maximize tumor resection while preserving the patient’s vision, which is crucial for maintaining independence and daily activities such as driving. The surgeon often finds that continuous monitoring of visual function adds confidence in safely performing a more complete resection. We also assess the patient’s visual function six weeks post-surgery to gauge the impact.
Physiotherapists are involved at all stages of the patient journey. Once the surgery is planned, we provide pre-assessment and prehabilitation to help prepare the patient for what to expect. Alongside our AHP colleagues and the surgeon, we continuously assess and test the patient to ensure the right balance between tumor removal and maintaining function. Immediately after surgery, we help assess any problems and create an individualized plan to improve the patient’s function and quality of life.
Leeds Teaching Hospitals has strong connections between our inpatient and outpatient neuro-oncology therapy services, ensuring a seamless transition of care for patients once they leave the hospital. This continuous involvement allows us to be proactive, meeting patients’ needs at the right time, unlike traditional therapy services which typically address issues only once they arise.
Occupational therapy assesses patients’ cognitive, perceptual, visual, and motor changes post-surgery. We use both standardized and functional assessments to ensure patient safety before discharge. We then refer patients to neuro-oncology rehabilitation services and local services to help them achieve their goals within their own environments.
Leeds Teaching Hospitals received the Tessa Jowell Center of Excellence for Brain Tumor Care accreditation in 2021, and I was fortunate to be appointed to the Tessa Jowell Academy’s founding committee last year, where I represent AHPs nationally. Through this academy, we’ve been able to network with neuro-oncology centers across the UK, sharing knowledge and, in some cases, helping AHPs become involved in awake craniotomies where they weren’t previously included. This collaboration has helped address disparities in this service across the country.