Successfully performed awake craniotomy with excision of tumour: A Case Study
Dr. Manish Kumar MBBS, DNB (Neurosurgery)
Surgical Case Reports 2017 © The Park Group of Hospitals. 2017
Awake craniotomy is a surgical operation similar to any conventional craniotomy while the patient is awake during the procedure. Awake Craniotomy is one of the most preferred techniques for operations of excision of tumors which involve or are close to the eloquent regions of the brain. This technique of craniotomy allows the neurosurgeons to test the brain region before incision / excision along with a regular check on the patient’s functionality during the surgery. An awake Craniotomy minimizes the risk of the patient during the operation. An old industrial worker was suffering from repeated seizures since 2014. The series of radiological investigations revealed an increasing left frontal region occupying lesion. The lesion was very close to the area of speech and right side limbs. To prevent this loss of speech and weakening of right side limbs of the patient, team carried out the Awake Craniotomy and the patient was discharged after a week’s observation and his speech was normal along with right side limbs movement.
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. 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.
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. 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.
According to Dr. Manish, awake craniotomy is a difficult yet preferred surgery during operations for excision of tumors which involve or are close to the eloquent regions of the brain. The patient is regularly monitored for movement and speech during the surgery and if in case patient’s verbal response or activities is reduced, the surgery has to be stopped. The limb response remains unchanged post successful surgery. The patient’s speech can be easily saved through awake craniotomy technique of surgery. Post surgery, the patient has regains speech and limb power back to normal.
Post surgery, the patient is very well and is also neither having any issues with the limbs movement or with speech. He is eating well and is able to talk properly and monitored by his regular visits.
The case study is presented with the consent of the patient and his family members. The Medical team at the Park Group of Hospitals including doctors, MD and MS were also taken prior approvals for the case study.