Rare brain surgery performed at SSG Hospital in Vadodara

49 years old Dhansukh Chouhan from Tamadi village in Bharuch was admitted to SSG Hospital with Convulsion and Speech disturbance. His MRI showed a tumour in the brain of the left side (Left insular glioma ).

The left side of the brain has speech areas and surgery in this area carries a risk of damaging these areas leading to loss of speech and understanding (called APHASIA).

Hence surgery of such tumours are done by a special technique called Awake Craniotomy with Intraoperative Neuromonitoring (IONM). The doctors decides to use the technique to operate on the patient by continuously talking to him.

"It is important to note that brain is a painless structure and the skin over the brain is painful. In this technique, the patient is kept awake throughout the procedure. Local anaesthesia is given in the SCALP called Scalp block the effect of which lasts for 10-12 hours. The skull is then opened (called craniotomy). Then using intraoperative Neuromonitoring the speech areas are identified by stimulating various areas of the brain and asking the patient to speak. If near any area, the patient stops speaking(called speech arrest), then that area is marked as speech area and tumour from that area is not removed. Before removal of the tumour , the speech area is identified. Then surgery is carried out a little away from the speech area," said Dr .Amey Patankar Head of Neurosurgery Department SSG hospital Vadodara.

He further added, in our surgery 80% of the tumour was removed. During removal of the last 20%, the patient started developing speech disturbance and hence the surgery was stopped. The patient is in full conscious and able to speak and soon to be discharged. Postoperative MRI showed 80-85% tumour removal. This tumour can be treated further by radiotherapy.

Dr. Patankar said, the aim of the awake craniotomy was preservation of speech areas. If the operation was done under full general anaesthesia, then there was a high risk of patient losing his speech (aphasia). Hence, the objective in left side brain tumours is to preserve speech even though some tumour might have to be left behind. Because leaving some tumour behind is less problematic than making the patient permanently lose his speech.