Patient awake during a brain surgery at AMRI Hospitals, Bhubaneswar

amriBhubaneswar: The world was breaking up into pieces for 18-year old student Radhika (Name Changed), a resident of Bhadrak. But at AMRI Hospitals, Bhubaneswar she found new life when Dr Amit Jaiswal cured the brain tumour through a path-breaking procedure called Awake Craniotomy.
Awake Craniotomy is a unique operation performed in the same manner as a conventional craniotomy but with the patient staying awake during the procedure. This is a preferred technique for operations to remove lesions close to, or involving, functionally important regions of the brain, like area responsible for speech, for movement of limbs. This allows surgeons to test regions of the brain before they are incised or removed and patient’s functions continuously throughout the operation which helps minimize the risks of such operations.
Dr Jaiswal said, “Awake craniotomy is done rarely as all patients cannot be cooperative enough with the doctors and patient’s cooperation along with great coordination between the anesthesia team and surgeons are of utmost importance for this kind of surgeries. The anesthetist should know when the patient needs to be sedated and when he/she needs to be in senses to communicate with the doctors. After brain surgeries in spite of being cured many female patients become emotionally unstable as their head is shaved off, so I ensure that I make a minimum cut and don’t shave the head completely.”
“At AMRI Hospitals, Bhubaneswar we have always tried to achieve excellence in medical service. What gives us maximum pleasure is to see happy patients leaving our facility. The Awake Craniotomy performed by Dr Jaiswal has been a commendable effort and we are very pleased with its all round success,” said Dr. Salil Kumar Mohanty, SM, VSM, Surg Rear Adm (Retd) Vice President AMRI Hospitals, Bhubaneswar.
Radhika suffered from a seizure (epileptic fit) and was put under a neurophysician’s medication. In spite of the medication she got no respite from the seizures. After undergoing several clinical tests, a CT scan revealed a tumor located on the motor area on the left side of the brain. This part of the brain is responsible for movement of the right side of the body. Radhika needed a surgery to remove the tumor. For this she consulted many doctors, who warned that post-operation there was very high chance that she would become paralytic on her right side and she might lose her speech too.
Then she came to Dr. Amit Jaiswal Consultant Neurosurgeon, AMRI Hospitals. A functional MRI revealed that the tumor was exactly on the motor area of the brain. Dr Jaiswal realized that if the operation was done in a conventional manner, she would become paralytic on her right side. So he chose a unique method of “Awake Craniotomy”.

“Another significant point is that the surgery was not done under general anesthesia. Instead local anesthesia and some sedation were used for the surgery so that the patient could interact with the surgeon during the operation. It might seem bizarre to think about brain surgery under local anesthesia. It sounds odd that somebody’s head is being opened up and the surgeon is fiddling in the brain, while the patient is awake. But that was the need of the hour,” Dr Jaiswal added.
Radhika was explained well before the operation about the whole procedure. Unless she was fully aware of the procedure, she would not have been able to cooperate during the procedure. She was explained that unnecessary movement by her during the operation could be disastrous. The coordination between the operative team and the anesthesia team also had to be impeccable. The patient needed some kind of sedation during some parts of procedure. The level of sedation was titrated closely and was kept under tight control.

Dr Jaiswal further said: “MRI land Marks were used to mark out the incision and instead of shaving the head a very small amount of hair was clipped along the line of incision. During cutting of the skin and cutting of the bone the level of sedation was deepened. When the brain was exposed, the level of sedation was lightened, because at this time the doctors needed to communicate with the patient. Also while operating, intermittently Radhika was asked to move her limbs or count from one to hundred, which she did well.”
The tumor was removed completely in about four hours, without affecting right side of her body or speech. After removal of tumor the patient was sedated again and the bone flap was replaced and the wound was closed. Post operation medication was suggested for a couple of months and now she is absolutely fit. There has been no threat of paralytic attack also.
“I have got a new life here. The operation was serious and lengthy. But I had faith on my doctor and he has given me a new life. I am grateful to AMRI Hospitals, Bhubaneswar also for the way I have been taken care of,” Radhika said, after the operation.

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OdishaInc Bureau