KUALA LUMPUR, March 14 (Bernama) -- Universiti Kebangsaan Malaysia achieved yet another milestone when a patient was made to wake up during a brain surgery last month.
It was the UKM Medical Centre first Awake Craniotomy, a procedure to remove brain tumor with minimal or no brain damage to the patient, according to UKM's news portal.
Some might think that waking up during surgery is terrifying but in this case it was intentional. The patient needed to be conscious to monitor and preserve his brain functions.
UKM said that it is no secret that Awake Craniotomy is a very scary option to the patient. So before a patient undergoes the procedure, he or she is counselled and guided every step of the way.
The university said its patient is now recovering splendidly.
The procedure was performed by UKM Neurosurgeon, Associate Prof Dr Ramesh Kumar, and assisted by three other surgeons, Dr Toh Charng Jeng, Dr Sanmugarajah Paramasvaran and Dr Ainul Jaffar.
Dr Esa Kamuruzaman was the anesthetist responsible in sedating the patient before his skull was opened up and then brought back to consciousness during the surgery, just before the tumor is cut out.
UKM said the complex surgery is commonly done to remove tumors that grow in the eloquent brain.
"These are areas of the brain that allow us to communicate, perceive, interact and have movement. They regulate our senses, movement and speech, a very important part of living a normal life.
"What is fascinating about the unique procedure is the patient participated in his surgery by giving feedback to the surgeon, who in turn will react accordingly. It is quite a scene when the patient wakes up during the operation and starts responding to questions," said UKM.
When asked why a patient need to be awake during the surgery, Dr Ramesh explained,"This technique was developed to allow maximum excision of the lesion while causing minimum or no injury to the surrounding normal brain tissue so that the patient has minimal or no functional loss.
"The best way to know that the patient has his functions intact is from his response. You cannot know this when the patient is unconscious."
Dr Ramesh said the patient would be asked to perform simple task related to the critical area while the tumor is removed.
Any changes in function are monitored and the surgeon stops further dissections in the related area if any adverse effect is detected. Though current scanning technology like MRI can pin point where the tumor is but it is not accurate enough.
"By resorting only to the MRI scan, the surgery will be very much like walking in a mine field. Any damage to eloquent areas even by a millimetre can mean living with a disability for the rest of the patient's life. It might harm the ability to speak or move or even think.
"Although functional MRI can show the motor and speech areas, it may not accurately pin point the most important areas and therefore the brain mapping done with direct electrical stimulation on the brain while the patient is awake remains as the most reliable avenue for neurological preservation," Dr Ramesh said.
UKM explained that the brain is not very good at healing itself and if any nerve is damaged it is not going to regenerate.
The patient is given general anesthesia before commencing surgery to render him unconscious. Then the surgeon will get to work and start drilling his skull to gain access to the patient's brain.
Dr Ramesh said sedation is given at the start because the scalp and pericranium (tissue overlying the bone) is pain sensitive while the brain is not.
"Once the skull is opened the anesthesia is reversed and the patient is awakened. Upon completion of the excision of the lesion, the patient is put to sleep again and the skull opening is then closed."
It was the UKM Medical Centre first Awake Craniotomy, a procedure to remove brain tumor with minimal or no brain damage to the patient, according to UKM's news portal.
Some might think that waking up during surgery is terrifying but in this case it was intentional. The patient needed to be conscious to monitor and preserve his brain functions.
UKM said that it is no secret that Awake Craniotomy is a very scary option to the patient. So before a patient undergoes the procedure, he or she is counselled and guided every step of the way.
The university said its patient is now recovering splendidly.
The procedure was performed by UKM Neurosurgeon, Associate Prof Dr Ramesh Kumar, and assisted by three other surgeons, Dr Toh Charng Jeng, Dr Sanmugarajah Paramasvaran and Dr Ainul Jaffar.
Dr Esa Kamuruzaman was the anesthetist responsible in sedating the patient before his skull was opened up and then brought back to consciousness during the surgery, just before the tumor is cut out.
UKM said the complex surgery is commonly done to remove tumors that grow in the eloquent brain.
"These are areas of the brain that allow us to communicate, perceive, interact and have movement. They regulate our senses, movement and speech, a very important part of living a normal life.
"What is fascinating about the unique procedure is the patient participated in his surgery by giving feedback to the surgeon, who in turn will react accordingly. It is quite a scene when the patient wakes up during the operation and starts responding to questions," said UKM.
When asked why a patient need to be awake during the surgery, Dr Ramesh explained,"This technique was developed to allow maximum excision of the lesion while causing minimum or no injury to the surrounding normal brain tissue so that the patient has minimal or no functional loss.
"The best way to know that the patient has his functions intact is from his response. You cannot know this when the patient is unconscious."
Dr Ramesh said the patient would be asked to perform simple task related to the critical area while the tumor is removed.
Any changes in function are monitored and the surgeon stops further dissections in the related area if any adverse effect is detected. Though current scanning technology like MRI can pin point where the tumor is but it is not accurate enough.
"By resorting only to the MRI scan, the surgery will be very much like walking in a mine field. Any damage to eloquent areas even by a millimetre can mean living with a disability for the rest of the patient's life. It might harm the ability to speak or move or even think.
"Although functional MRI can show the motor and speech areas, it may not accurately pin point the most important areas and therefore the brain mapping done with direct electrical stimulation on the brain while the patient is awake remains as the most reliable avenue for neurological preservation," Dr Ramesh said.
UKM explained that the brain is not very good at healing itself and if any nerve is damaged it is not going to regenerate.
The patient is given general anesthesia before commencing surgery to render him unconscious. Then the surgeon will get to work and start drilling his skull to gain access to the patient's brain.
Dr Ramesh said sedation is given at the start because the scalp and pericranium (tissue overlying the bone) is pain sensitive while the brain is not.
"Once the skull is opened the anesthesia is reversed and the patient is awakened. Upon completion of the excision of the lesion, the patient is put to sleep again and the skull opening is then closed."
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