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Awake during brain surgery

Moubani Karmakar. Photo: Sushanta Patronobish

Moubani Karmakar. Photo: Sushanta Patronobish   | Photo Credit: Sushanta Patronobish

Moubani Karmakar, 18, who suffered frequent seizures, was diagnosed with brain tumour

Moubani Karmakar, an 18-year-old student who suffered frequent seizures, was diagnosed with a brain tumour and had to undergo a surgery. But unlike most patients, Moubani stayed awake as doctors worked at removing the tumour — moving her right arm or leg or counting up to 100 when instructed to do so.

The tumour in her brain was located in the motor area on the left side of the brain — the part responsible for movements on the right side of the body. The lesion was also critically close to the area in the brain that controls speech, said neurosurgeon Amitabha Chanda, who conducted an “Awake Craniotomy” on Moubani, said talking to journalists on Tuesday.

Doctors had warned the girl that if she went under the knife there was a high risk that the right side of her body would become paralysed or she may suffer a loss of speech. It was thus decided that the operation will be conducted under local anaesthesia and sedation so that she can interact with her doctors throughout the procedure, said Dr. Chanda.

“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,” he added.

The problem lies in the fact that it is difficult to distinguish between the tumour and normal brain tissue, particularly at the junction, he explained. During the operation, if Moubani felt any discomfort in her right limbs she could tell Dr. Chanda and he would know that he had moved close to the brain tissue. The doctors could also ask her to move an arm or speak out loud so that they knew that they had not caused any damage.

The high-risk procedure depends on a great deal of coordination between the anaesthetist and the surgeon, as well as cooperation from the patient. Even a slight jerk could lead to the bruising of a blood vessel, causing significant damage.

There was also the chance of the patient having a fit during the surgery and so had to be administered high doses of anticonvulsants, Dr. Chanda said.

“Some phases of the operation — when the incision was made or when cutting through the bone — were painful. However, once access to the brain is achieved the surgery is painless. So the anaesthesia and the sedation had to be carefully regulated to keep her asleep during the painful parts and awake later on,” said anaesthetist Sucharita Chakrabarti. The four-hour-long procedure cost the Karmakar family Rs.2 lakh.

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Printable version | Feb 24, 2020 8:40:24 PM | https://www.thehindu.com/news/national/other-states/awake-during-brain-surgery/article3547980.ece

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