Posted on 4 August 2013 - 10:57pm
Last updated on 5 August 2013 - 02:37pm
KUALA LUMPUR (Aug 4, 2013):
Imagine being wide awake while a surgeon is cutting into your brain. And without anaesthesia to boot.
You will also have to answer questions about how you are feeling at that point in time besides telling the surgeon your immediate concerns, if any.
A surgeon is carrying out "awake craniotomy" on brain tumour patients at Universiti Kebangsaan Malaysia Medical Centre (PPUKM) with more than a dozen such operations carried out here in the recent past.
The man who is making waves with this surgery is neurosurgeon Dr Ramesh Kumar (pix), who was trained in Leeds, United Kingdom. He is an expert at removing brain tumours with no brain damage to the patient.
"This kind of surgery is commonly done for tumours located in or around eloquent areas such as the motor, sensory or speech controlling areas of the brain," Ramesh told theSun.
These are areas of the brain that allow communication, thought perceiving, interaction and movement. They also regulate the senses, movement and speech.
This technique was developed to allow maximum tumour resection while minimising or preventing injury to the surrounding normal brain tissue.
"The patient has minimal or no functional loss (neurological deficit)," said Ramesh, who had carried out his first "awake craniotomy" in Malaysia on Feb 8 this year.
Ramesh said one of the main benefits of an "awake craniotomy" is that feedback is live and carried out directly with the patient as the surgery is ongoing.
The key to the painless surgery is this: the brain has no pain fibre and so the patient feels no pain.
"This is why awake craniotomy can be done on a person's brain. Pain fibres are only located on the scalp and pericranium (tissue overlying the bone)," he said.
Ramesh said although the surgery is called "awake craniotomy", the patient is not 100% awake during the surgery as the procedure is to allow the patient to be anesthetised, be awakened and then anaesthetised again.
The patient is initially put on a short acting general anaesthesia while a scalp block and craniotomy is performed. He is then awakened and required to answer questions on how he is feeling.
"Once the skull is opened, we awaken the patient and ask them to perform tasks related to the critical area as in motor, sensory or speech control while the lesion is being removed. Upon completion of the removal of the lesion, the patient is put to sleep again to close the skull opening," Ramesh added.
According to him, such surgery cannot be performed on every brain tumour patient as age is a consideration besides reasonable intellectual ability to communicate and follow instructions during the surgery.
Ramesh said a lot of counselling is given to potential patients before such surgery can be performed.
"I want them to understand the entire process. Such counselling also involves the anaesthetist, physiotherapist and speech therapist," he said.
Prior to an operation, the patient has a Magnetic Resonance Imaging (MRI) scan of the brain. Although a functional MRI can show the motor and speech areas, it may not accurately pinpoint the most important areas.
Therefore, brain mapping is also done with a direct electrical stimulant used on the brain.
Ramesh said an additional imaging called a tachtography or Diffusion Tensor Imaging (DTI) is also done as it provides an image of where the wiring of the brain is and where the tumour is located.
During his first awake craniotomy in PPUKM, Ramesh was assisted by three other neurosurgeons: Dr Toh Charng Jeng, Dr Shanmugarajah Paramasvaran and Dr Ainul Jaffar while Dr Esa Kamuruzaman was the anaesthetist.
The anaesthetist plays a vital role in the surgery as it is his duty to sedate the patient before his skull is opened up. He also helps bring the patient back to consciousness during surgery just before the tumour is cut out.
Brain op: 'Awake' woman tells all
A patient who underwent awake craniotomy last Wednesday heard most of what was being said during the surgery to remove a tumour in her brain.
She said it was unbelievable to hear so many people talking around her while Universiti Kebangsaan Malaysia Medical Centre (PPUKM) neurosurgeon Dr Ramesh Kumar operated on her.
"I could also see anaesthetist Dr Esa Kamuruzaman as he went through some feedback exercises with me. All this created a very calming atmosphere. I would encourage people who are diagnosed with brain tumour to go for this method of surgery," she added.
The patient, who requested anonymity, is grateful that she was introduced to this method of surgery.
"When I found out that I had a brain tumour, I was shocked and frightened. I know what it feels like to have cancer as I was a breast cancer patient. Except this time, I had confidence in Dr Ramesh to operate on me.
"Although I had not heard about this method of operation before, I agreed because he gave me a very detailed explanation about the process and how surgery is done for brain tumours," she said.
The patient said it felt surreal being conscious while surgery was being performed on her.
http://www.thesundaily.my/news/788790
