Brain surgery of any kind is a frightening prospect.

But imagine undergoing such an operation while you are wide awake and able to talk to the surgeon carrying it out.

Teenager Alexandra Hodge is the youngest person in Britain to have endured this procedure as doctors tried to remove a tumour.

As she lay on the operating table for the fourth round of surgery on her brain, the 14-year-old was able to advise neurosurgeon Henry Marsh: "Make sure it's all out."

Alexandra was in good hands - Mr Marsh is one of the few surgeons in the world to carry out this type of operation.

He recently featured in the BBC documentary Your Life in Their Hands, which followed the story of Adrian Theobald, 30, an insurance broker from London with a brain tumour.

Adrian was seen lying awake on the operating table, talking to Mr Marsh.

The theory is that it is easier to operate on some people with tumours while they are awake so they can communicate with the surgeon during the procedure.

This can indicate whether their brain is being affected or damaged while the surgeon cuts out as much of the tumour as possible.

Adrian answered a series of questions but when his responses became muddled, the surgeon knew he could not cut any deeper.

Alexandra bravely watched the documentary before she underwent the procedure at St George's Hospital, Tooting, London.

The teenager has been battling cancer for more than two years.

It began in summer 2002, when her mum Elaine, 42, and dad Nick, 50, noticed their daughter was having "blank- outs".

Elaine, of Brighton Road, Lancing, said: "She would go blank for a couple of minutes. She didn't remember anything about it after they happened."

A doctor diagnosed a type of epilepsy and she was given medication but by November 2002 it was obvious the drugs were not working, so she was sent for an EEG, using electrodes on the patient's head to monitor brain activity.

It was clear there was a problem, so she was sent to Worthing Hospital in November for an MRI scan, which gives a cross-section image of the brain. Elaine, said: "They told us there and then they had found a tumour but they couldn't tell us anything more. I remember the day clearly. It was a Friday and it was a horrible weekend.

"We didn't tell Alexandra at the time. We wanted to get ourselves together although she could see we were distressed."

Alexandra's scans were sent to the Atkinson Morley Hospital in London for examination where the diagnosis was confirmed and she was called in to hospital for an operation on the Wednesday to remove the tumour.

Elaine, who has two other children, Joshua, 12, and Bethany, eight, said: "They shaved her head and gave her a craniotomy. She was in theatre for three-and-a-half hours.

"When she came out she had 40 staples in her head. They discovered that the tumour was causing the blank-outs. The surgeon told us he was 99 per cent sure he had got it all out."

The family waited anxiously for the laboratory tests on the tissue. It was benign.

Alexandra, then a pupil at Sandhurst School, Worthing, was told she would have to be scanned regularly for the next few years as a precaution.

Elaine said: "We had a good year after that. Alexandra was back at school and the blank outs had stopped."

But in November 2003, the results of another routine scan sparked concern.

Before long, Alexandra was back in hospital for three and a half hours of surgery to remove the tumour which had re-appeared. The tissue was once again sent off for tests. The news was mixed.

Elaine said: "It was a difficult time. It was benign but more aggressive and there was still a chance it could grow back and if it did there would have to be some radiation treatment."

A week before the next scan, Alexandra, who by now attended Boundstone Community College in Lancing, fell ill with a fever and headaches.

The next batch of results showed it had grown again. Alexandra would have to face her third operation.

Elaine said: "I couldn't believe it. It was like a nightmare. I told her that the reason she was feeling poorly was because the tumour had come back. She was really upset. We just thought we were getting things straight again."

In June 2004 Alexandra had her third operation at St George's Hospital in Tooting. The news which came back from theatre was not good.

Mr Marsh told the family he thought the tumour was now malignant.

Elaine said: "It was terrible. She was in intensive care and she was crying because she thought she had cancer. It was the worst thing you can imagine."

A few days after the operation, Mr Marsh got the family together and told them he wanted to operate on Alexandra's brain for a fourth time to remove as much of the tumour as possible but without leaving her brain damaged or paralysed.

This would mean operating on her while she was awake.

At just 13, she would be the youngest person in Britain to undergo the operation.

Once in theatre, Mr Marsh asked her questions throughout and asked her to move her left leg. There were concerns if he cut too deeply he would leave her left side paralysed.

Alexandra says she remembers hearing a sucking noise and having a headache while she was awake in theatre.

In July 2004 the family were told the tumour was definitely malignant and Alexandra underwent six weeks of radiation treatment and chemotherapy every day for six weeks.

She lost her hair but remained determined to bounce back and the family went on holiday to Portugal, taking Alexandra's best friend Penninah Kennard with her.

She even returned to school in September and her routine scan in November was clear. The family hoped their two-year nightmare was over.

But at the end of January this year she developed back pain.

It worsened and Alexandra, who was undergoing chemo-therapy, was admitted to Worthing General Hospital for nine days and then transferred to the Royal Marsden in London for further scans.

The scan showed the cancer had moved to her back. Alexandra is due to start a new course of chemotherapy on March 14.

Despite her long battle with her health she has remained cheerful and is planning to work with children with difficulties when she leaves school. She is also planning her work experience.

Elaine said: "It has been very difficult as we have two other children to support but Alexandra is strong and positive. She is so brave and has gone through a lot."

A strong source of support for Alexandra has been the Post Pals web site, which was started by Sussex girl Vicky Miles and two friends who themselves have undergone long-term illness.

The site allows young people who are ill and perhaps cannot get out and about to chat to other people around the world.

Elaine said: "It's a difficult enough time in your teens without having to battle something like this.

"Alexandra has a very good outlook. I would advise anyone going through this to talk and not to bottle things up."