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Doc chats up patient through speech-zone brain surgery

Small talk between doctor and patient is a rarity when a brain tumour is involved. More so, when the patient is on the operating table. But,...

Written by Johnson T A | Bangalore |
May 2, 2002

Small talk between doctor and patient is a rarity when a brain tumour is involved. More so, when the patient is on the operating table.

But, in a rare medical event, Bangalore-based neuro-surgeon A.S. Hegde and his medical team at the Sathya Sai Hospital had to indulge in idle chatter with their patient as they removed a tumour in the speech zone of his brain.

The constant patient-medical team banter was necessary to ensure that the doctors were not causing any harm to the speech region of their patient Mahesh Rao’s brain.

To Rao (name changed on request), a middle-aged senior manager in a software firm, normal speech was a matter of having a livelihood. He had been diagnosed with a brain tumour after he had suffered a seizure that left him speechless for close to five hours. Scans and investigations revealed a tumour on the left side of his brain, very close to his speech and writing zone.

Rao was then offered a choice of undergoing a computer-aided normal navigational brain surgery or an ‘awake’ surgery that allows constant monitoring of speech on the operating table. He took the ‘awake’ option.

According to Dr Hegde, ‘awake’ brain surgeries are a rarity and are conducted only when functional areas of the brain, like the speech zone, are involved. ‘‘Brain surgeries are unusual and difficult since the brain controls all systems in the body and is located in a rigid, closed space. Functional areas, in particular, are critical. And in an ‘awake’ surgery, the margin for error is greatly reduced,’’ he said.

The surgery was definitely not easy on Rao either. His head, numbed with local anaesthesia, had to stay fixed during the operation. The slightest movement could mean damage to the brain. So throughout the surgery the medical staff were chatting with him, asking him if he could feel sensations in his toes, other parts of his body, etc.

‘‘Patients may agree to go for an ‘awake’ surgery but tend to become restless as it progresses because the brain is not used to external atmospheric pressure, so the head has to be immovable,’’ said Dr Hegde.

Rao’s malignant tumour was removed and he was wheeled out of the surgery room after nearly two hours. He has, subsequently, been undergoing radiation therapy to prevent re-emergence of cancerous cells. ‘‘Once a tumour is removed it improves neurological functioning, provides rapid cell kill and prolongs survival,’’ said Dr Hegde.

According to Dr Hegde, modern brain surgery technologies have advanced to a extent where surgeons can zero in on tumours using computer-aided systems that act like the global positioning systems on a modern fighter plane. ‘Awake’ surgery, in this context, is just one of the options available to a surgeon, he said.

This is the second ‘awake’ surgery being reported from the city. The Wockhardt Hospital had, in January, conducted a complex bypass surgery on a 78-year-old patient by only using local anaesthesia.

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