What treatment options are available for patients who have been diagnosed with a tumour that’s located at a very near region in the brain controlling motor functions, speech and the ability to comprehend language?
Having your eyes wide awake during brain surgery sounds more like a concept from the imagination of a futuristic movie director but performing brain surgery while the patient is conscious, is very much alive here and now in Malaysia.
Awake brain surgery was pioneered decades ago in epilepsy patients where surgeons would keep patients alert enough to ensure they were destroying the tissue in the brain that caused uncontrolled seizures, without damaging other tissues.
But it wasn’t until the recent introduction of brain-mapping technology—which allows doctors to identify the eloquent areas of the brain—and advancement in anaesthesia, that more neurosurgeons became comfortable with the idea of waking their patients while they performed surgery.
Awake brain surgery is a procedure that is usually done to remove tumors located in or around what is referred to as the eloquent areas, which include the motor, sensory or speech controlling areas of the brain, while causing minimum or no injury to the surrounding normal brain tissues.
Thus, preserving the important functions of the brain to avoid severe disability.
What happens during an awake brain surgery? When the brain is exposed neurosurgeons will perform a procedure called cortical mapping. This involves stimulating the brain surface with a brain stimulator, by mapping out the important regions of the brain. In doing so, surgeons can avoid destroying areas of the brain that controls speech or motor functions. While surgeons remove the tumour they will continue to test the patient’s functions.
Today, awake surgery is expanding beyond the brain. Awake surgery is used by head and neck surgeons who implant prosthetic devices to replace damaged vocal cords, for instance.
Whilst, the aim of the surgery is to remove as much of the tumour as possible, while minimising damage to surrounding healthy brain. Sometimes it is not safe or possible to remove all visible tumour tissue because it is too close to important areas of healthy brain and this is where the Cyberknife can be taken into consideration. CyberKnife, delivers multiple beams of x-rays using a robotic arm. It is image-guided so it can adjust to the natural movements of the organs and work anywhere in the body. It is used for the treatment of certain lung, brain, spine, liver and prostate cancers which otherwise may be inoperable, or where other treatment options may compromise other vital organs. CyberKnife treatments are delivered in one session or can be staged over several days. Typically brain cancer treatments are completed within five days. For most patients the CyberKnife treatment is a completely pain-free experience.
Written by: Dr Chee Chee Pin, Senior Consultant Neurosurgeon, Beacon Hospital Malaysia