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Park Hospital, Gurugram successfully completed first awake craniotomy

  • Park Hospital, Gurugram successfully completed first awake craniotomy

Dr. Manish Kumar a highly experienced neurosurgeon at the affordable super specialty hospital performed a successful awake craniotomy for a patient with seizure disorder.

Gurugram, Haryana: The affordable super specialty hospital at Park Hospital Gurgaon, announces to have successfully performed an awake craniotomy for a 42 year old industrial worker.

A 42-year-old gentleman who is an industrial worker was suffering from repeated seizures since 2014. A series of radiological investigations revealed an increasing left frontal space occupying lesion since 2014; features suggestive of Glioma The lesion was very close to the area of speech (as it was involving the dominant side – the working side for a right-handed person) and right side limbs. In case, a complete excision with good clearance of the tumor had been attempted as there was risk of loss of speech and weakening of right side limbs due to the position of the tumour. To prevent this loss of speech and weakening of right side limbs of the patient, Dr. Manish Kumar, MBBS, DNB (Neurosurgery) carried out the Awake Craniotomy with his team of doctors and technicians.

Dr. Manish Kumar explains that, “Awake craniotomy is a method of performing brain surgery where in the patient is given local anesthesia and intravenous anesthesia to keep him calm and pain free. It’s different from the usual anesthesia where mainly different gasses are used as a sedative and a deep anesthesia is achieved.” He further added, “In such critical cases, it is very important that the patient and relatives understand the pros and cons of the surgery and co-operate accordingly.”

The risk of loss of speech and right-side limb weakness with the immediate need for the surgical excision was explained by the team to the patient and his relatives and a possible safer option of awake craniotomy was discussed.

Craniotomy lasted for around three hours and was successful with patient co-operation. The tumour was removed satisfactorily; however the surgery had to be stopped for a while as patient’s verbal response had developed slowness. The limb response was unchanged. The patient’s speech was saved through the awake craniotomy technique of surgery. Post surgery, the patient has regained his speech and limb power back to normal.

Dr. Manish Kumar who has earlier also conducted epilepsy surgery, Cervico-Thoracic Junction Fixation  and odontoid fixation with other technically demanding surgeries at the Park Hospital Gurugram, mentioned that this surgery was possible only because of the good team of doctors and technicians as well as the advanced technology available at the hospital premises. This patient and relatives were very understanding and they appreciated the idea of protecting the patient by doing painless but awake surgery.

Brain Craniotomy

  • Brain Craniotomy

Successful Craniotomy done with Excision of Tumor (Enplaque Maningioma): A Case Study

Dr. Anil Arya MBBS, MS, DNB (Neuro Surgeon)
Surgical Case Reports 2017 © The Park Group of Hospitals. 2017

Abstract

“En plaque meningioma refers to a specific meningioma macroscopic appearance characterised by diffuse and extensive dural involvement, usually with extracranial extension into calvarium, orbit, and soft tissues. These tumours are thought to have a collar-like or sheet-like growth along the dura mater, different from the usual globular meningioma.”* This type of brain tumour is highly vascular and involves risky operation. Being a very rare type of tumour, this needs intensive care. A 45 year old woman with a progressive increasing headache on the right side of the brain for last years, who was also misdiagnosed by a private hospital in Sonepat, visited Park Hospital Panipat. The team at Park Hospital Panipat started the treatment with MRI and brain investigations wherein the En-Plaque Meningioma was diagnosed. There was pain and bulginess in both eye balls due to the tumour and weakness on the left side. The patient was discharged after a week of intensive observation and once we saw recovery signs in her with the ability to move smoothly her limbs.

Background

En-Plaque Meningioma is a rare type of brain tumour and requires intensive care. This is one of the slow growing benign tumours which is attached to the dura and are made up of neoplastic meningothelial cells. These are more common in Western World reporting around 24-30% cases. Meningioma en plaque represents a morphological subgroup within the meningiomas defined by a carpet or sheet-like lesion that infiltrates the dura and sometimes invades the bone. Histopathological features of meningioma enplaque are similar to that of usual meningiomas; however, it is sometimes difficult to predict the behavior in individual cases. Extra-cranial meningiomas form 1-2% percentages of all meningiomas. ** The en plaque variants commonly involve fronto-parietal, juxtaorbital, sphenoid wing, diffuse calvarial or rarely spinal region. *** Due to difficulty in complete resection, the recurrence rate of en plaque meningiomas is higher than the usual counterpart. **** These tumors are also more prone to develop malignant change (11%) when compared to intracranial meningiomas.

Case Presentation

A 45 year old woman visited Park hospital Panipat for an OPD consultation with Dr. Anil Arya wherein he studied the MRI reports and after brain investigations, he diagnosed a rare brain tumour. The lady had progressive increasing headache on the right side of the brain for last 5 years. However, for last 2 years there was pain and bulginess in both eye balls. The patient visited a private hospital in Sonepat for the treatment wherein the CT head was performed and based on the same she was misdiagnosed with Subdural Hematoma. During the operation, the doctor confirmed that the case is of Brain tumour. She was then referred to GB Pant Hospital in New Delhi for further treatment. However, she did not receive any treatment or response; thereafter she contacted Dr. Anil Arya at Park Panipat. After explaining the complexity of the surgery and the poor prognosis during and after the surgery, with due permissions, the patient was operated on 27th July 2017. The tumour mass was completely removed from the brain with craniotomy. Post operation, the patient is conscious oriented with signs of difficulty in limb movement.

Discussion
As per Dr. Anil Arya, “The surgery was very complicated and could have risked the life of the patient as well.”

Conclusion

Post surgery, the patient is very well and is also not having any issues with the limbs movement and is also not experiencing any limb weakness.

Declarations

The case study is presented with the consent of the patient and his family members.

References

*Basu K, Majumdar K, Chatterjee U, Ganguli M, Chatterjee S. En plaque meningioma with angioinvasion. Indian J Pathol Microbiol 2010;53:319-21
**Perry A, Louis DN, Scheithauer BW, Budka H, von Deimling A. Meningiomas. In: Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, editors. Pathology and Genetics, World Health Organization Classification of Tumours of the Central Nervous System. 4th ed. Lyon: IARC press; 2007. p. 164-72.
**De Jesus O, Toledo MM. Surgical management of meningioma en plaque of the sphenoid ridge. Surg Neurol 2001;55:265-9.
***Muzumdar DP, Vengsarkar US, Bhatjiwale MG, Goel A. Diffuse Calvarial Meningioma: A Case Report. J Postgrad Med 2001;47:116-8. [PUBMED] Medknow Journal
***Klekamp J, Samii M. Surgical results for spinal meningiomas. Surg Neurol 1999;52:552-62. [PUBMED] [FULLTEXT]
****Akutsu H, Sugita K, Sonobe M, Matsumura A. Parasagittal meningioma en plaque with extracranial extension presenting diffuse massive hyperostosis of the skull. Surg Neurol 2004;61:165-9. [PUBMED] [FULLTEXT]
****Yamada S, Kawai S, Yonezawa T, Masui K, Nishi N, Fujiwara K. Cervical extradural en-plaque meningioma. Neurol Med Chir (Tokyo) 2007;47:36-9. [PUBMED] [FULLTEXT]
****Shuangshoti S. Primary meningiomas outside the central nervous system. In: Al-Mefty O, editor. Meningiomas. New York: Raven Press; 1991. p. 107-28.