UKMMC remove brain tumours on ‘wide awake’ patients

Posted on 4 August 2013 - 10:57pm
Last updated on 5 August 2013 - 02:37pm

Soo Wern Jun 

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

The Twist - Chubby Checker (Videos)

Brings a smile whenever I watch these videos.

I can't help noticing how slim everyone was in those days, almost 3 generations ago.

Enjoy!



(Not sure what happened to this video)
http://www.youtube.com/watch?v=qApIQt4qKjg




http://www.youtube.com/watch?feature=player_embedded&v=im9XuJJXylw




http://www.youtube.com/watch?v=eh8eb_ACLl8

Joe Cocker in Concert (Videos)

Joe Cocker - Into The Mystic (LIVE in Baden) HD


http://www.youtube.com/watch?v=gdgxxanQSec

October 15, 1996
Baden-Baden,Germany

Composer : Van Morrison

The Band :
Acoustic Guitar - Dean Parks
Steel/Dobro/Lead Guitar - Greg Leisz
Keyboards - Chris Staiton
Keyboards - Ken Stange
Bass - Hutch Hutchinson
Drums - Jim Keltner
Vocals - Maxine Sharp
Vocals - Stacy Campbell

Lyrics :

We were born before the wind
Also younger than the sun
Ere the bonnie boat was won as we sailed into the mystic

Hark, now hear the sailors cry
Smell the sea and feel the sky
Let your soul and spirit fly into the mystic

And when that fog horn blows,you know I will be coming home
And when that fog horn blows I've got to hear it
I don't have to fear it
I want to rock your gypsy soul
Just like way back in the days of old
And magnificently we will float into the mystic

Guitar Solo :

And when that fog horn blows you know I will be coming home
And when that fog horn whistle blows I've got to hear it
I don't have to fear it
I want to rock your gypsy soul
Just like way back in the days of old
And together we will float as we said into the mystic

We were born before the wind
Also younger than the sun
Ere the bonnie boat was won as we sailed into the mystic


Joe Cocker - A Whiter Shade Of Pale (LIVE in Berlin) HD


http://www.youtube.com/watch?v=hjBZllDo_8E

31 October 1980
Metropol, Berlin, Germany

Composers : Gary Brooker, Keith Reid, Matthew Fisher
This song is Procol Harum cover

The Band :
Lead Guitar - Cliff Goodwin
Bass - Howard Hersh
Keyboards - Larry Marshall
Piano,Arranger - Mitch Chakour
Drums - B.J. Wilson
Vocals - Maxine Greene
Vocals - Ann Lang
Vocals - D.E. Washburne

Lyrics :

We skipped the light fandango
Turned cartwheels 'cross the floor
I was feeling kinda seasick
But crowd called out for more
The room was humming harder
As the ceiling flew away
When we called out for another drink
The waiter brought a tray

And so it was that later
As the miller told his tale
That her face, at first just ghostly,
Turned a whiter shade of pale

She said:"There is no reason
And the truth is plain to see."
As I wandered through my playing cards
And would not let her be
One of sixteen vestal virgins
Who were leaving for the coast
And although my eyes were open
They might just as well been closed

And so it was that later
As the miller told his tale
Her face, at first just ghostly,
Turned a whiter shade of pale

Guitar Solo :

And so it was that later
As the miller told his tale
That her face, at first was ghostly,
Turned a whiter shade of pale


Joe Cocker - Up Where We Belong (LIVE in Berlin) HD


http://www.youtube.com/watch?v=penGDi5Nl80

Across From Midnight Tour
Berlin, Germany
3 September 1997

Composer : Jack Nitzsche,Buffy Sainte-Marie,Will Jennings
This song is Buffy Sainte-Marie cover

The Band :
Keyboards & Harmonica - Ken Stange
Keyboards & Guitar - Mark Alexander
Bass - Warren McRae
Drums - Jack Bruno
Saxophone,Keyboards & Vocals - Steve Grove
Guitar & Vocals - Gene Black
Vocals - Stacey Campbell
Vocals - Maxine Sharpe

Lyrics :

Who Knows What Tomorrow Brings
In A World Few Hearts Survive

All I Know Is The Way I Feel
When Its Real I keep It Alive
The Road Is Long
There Are Mountains In The Way
But We Climb A step Every Day

Chorus:

Love Lift Us Up Where We Belong
Where The Eagles Cry On A Mountain High
Love Lift Us Up Where We Belong
Far From The World Below
Where The Clear Winds Blow

Some,They Hang On To Used To Be
Live Their Lifes Looking Behind

All We Have Is Here And Now
All Our Lives Out There To Find

The Road Is Long
And There Are Mountains In Our Way
But We Climb The Stairs Every Day

Chorus

Time Goes By No Time To Cry
Just You And I, Alone,Today

Chorus x2


Joe Cocker in Concert (Live in Baden-Baden, "Organic Tour" 1996)


http://www.youtube.com/watch?v=_b-Smv7CnGA


The Best of Joe Cocker (Live in Dortmund 1992)


http://www.youtube.com/watch?v=cMSfABJ729I

Tracklist:
01. Cry Me A River
02. Feelin' Alright
03. Hitchcock Railway
04. Many Rivers To Cross
05. Up Where We Belong
06. I Can Hear The River
07. Shelter Me
08. Please No More
09. Nightcalls
10. Now That The Magic Has Gone
11. You Can Leave Your Hat On
12. When The Night Comes
13. Love Is Alive
14. Unchain My Heart
15. Feels Like Forever
16. With A Little Help From My Friends
17. The Letter
18. Sorry Seems To Be The Hardest Word
19. You Are So Beautiful


Joe Cocker Live in Basel (AVO Session 2007)


http://www.youtube.com/watch?v=vVE8ZlrL1W8

Tracklist:
01. When The Night Comes
02. N´oubliez Jamais
03. Up Where We Belong
04. You Are So Beautiful
05. Summer In The City
06. Come Together
07. Just Pass It On
08. Don´t Give Up On Me
09. Hymn For My Soul
10. You Can Leave Your Hat On
11. Unchain My Heart
12. With A Little Help From My Friends


Joe Cocker - Full Interview - english - Number One


http://www.youtube.com/watch?v=aVT0G6MdFzg

Published on Dec 22, 2012