Seven-year-old Nitin (name changed), who complained of persistent headache and frequent bouts of fits, was diagnosed with brain tumour around vital blood vessels in the speech area. He required a surgery immediately, without which he would lose the ability to talk.
Doctors at the Institute of Neurosciences, Sakra World Hospital, where he was admitted, realised that the patient’s speech and limb movements had to be monitored during resection of the tumour.
“This is a preferred technique for operations to remove lesions close to or involving functionally important regions of the brain,” institute director Satish Rudrappa told The Hindu .
A team of neurosurgeons, led by Dr. Rudrappa and neuro-anaesthetists led by Sunil Kumar, who performed the awake craniotomy surgery, claimed it to be the first in the world on a patient so young.
“Awake craniotomy has been a great success in adults, but among children, a different set of challenges are involved like the ability of a seven-year-old to be able to cooperate during the five-hour procedure,” Dr. Rudrappa said.
Nitin was given regional skull block anaesthesia and the craniotomy was performed using conscious sedation (sleeping and easily arousable). Once the brain and the tumour were reached, the boy was kept awake to speak, answer simple questions and identify simple objects using pictures, while the surgeons removed the tumour and preserved important blood vessels without coagulation, Dr. Rudrappa explained. At the end of the procedure, after closure of the skull, the boy could talk normally without pain or discomfort. He was discharged within 48 hours and is on regular follow-up, he added.
Patient plays guitar during surgery
Meanwhile, 37-year-old musician Abhishek Prasad, who had musician’s dystonia (difficulty in moving left hand fingers), a rare nervous disorder, underwent a brain circuit surgery at Bhagwan Mahaveer Jain Hospital recently.
During the surgery, the patient was fully awake and played the guitar, to give the doctors feedback to locate the exact location of the target to be lesioned.
