Brain surgery done while patient was awake

Staff Reporter
Filed on December 29, 2009
Brain surgery done while patient was awake

The first-ever open brain surgery with the patient wide awake in the Gulf region was successfully conducted on a 38-year-old Indian patient at the ity SKMC last month.

The surgery included removal of a tumour from the patient’s brain located near the cells responsible for vocalisation and speech. A multi-disciplinary team of more than 20 medical personnel worked on the patient to ensure a successful operation.

According to a statement issued by the hospital on Monday, the patient (name withheld on request), who was brought to the Emergency Department in an unconscious state, had suffered several epileptic fits, post-critical transient aphasia (language impairment) and hemiparesis (muscle weakness on one side of the body).

A CT (computed tomography) scan and MRI (magnetic resonance imaging) of the brain showed a left frontal cortico-subcortical tumour, which was in the brain area responsible for the speech.

A biopsy of the lesion and the histopathology report showed an astrocytoma (cancer of the brain), which is an intermediate tumour between benign and malignant.

“The first line treatment of this kind of tumours is the surgical excision or at least partial excision of the lesion in order to reduce its volume and the mass effect on the brain,” said Dr Maher Mansour, consultant neurosurgeon who performed the six-hour surgery.

In order to avoid risk of post-op aphasia, Dr Mansour opted to have the procedure done with the patient conscious where they can assess his condition, ensuring that no cells from the normal brain are removed during the electrical stimulation in the tumour region.

Through very specific tests, which were repeated three times at each stimulated area, the speech therapy team assessed the patient’s speech during surgery. The patient was provided with local anaesthesia.

“The patient tolerated the six-hour procedure very well and he was speaking and moving on the operating table after the last suture,” said Dr Mansour.

Post-operative images of the patient’s brain showed that the tumour was totally removed and the brain was under normal pressure.

However, the histopathology analysis of the tumour showed Grade 3 Astrocytoma, which requires the patient to undergo radiation therapy.

Ten days after the surgery, the patient was discharged. He immediately went to India where he decided to have the radiation therapy.

Dr Mansour said the patient is currently doing well, speaking and moving freely with no pain.

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