Nagpur: In yet another milestone in medical science achieved by the doctors at Super Specialty Hospital (SSH) attached to the Government Medical College and Hospital (GMCH), a patient’s brain tumor was removed while he remained awake and observed his surgery. Called as an awake craniotomy (patient is awake while cutting the skull and conducting any surgical operation of the brain) in medical terms, this is first of its kind in the known medical history of Nagpur.
While the entire procedure was performed in one and half hours the patient was awake and talking to the anaesthetists and neurosurgeon. He was earlier counselled to react to the instructions like seeing, talking, moving limbs etc during the surgery and the 40 year old patient from Bhandara, Vijay Nanwatkar, cooperated very well.
“This is the first such awake procedure done in SSH. The patient was suffering from seizures, vomiting, and headache. The scan showed a tumour in the portion of the brain which controls the speech, limb movements and vision. To ensure that these functions are not affected during the surgery the patient is given only local anaesthesia while cutting the brain skull,” said Dr Lulu Fatema Vali, in charge of neuro-anaesthesia at SSH.
Dr Pramod Giri, Professor and head of neurosurgery department told media that the tumour was pressing over many important areas of the brain, thalamus and the brainstem and Wermickes (the area responsible for comprehension in brain). “Hence instead of performing the surgery in general anaesthesia where the surgeon would not know the effect of the surgery while operating we decided to conduct awake craniotomy so that we could save all the basic functions of the body. It was the only solution for best results,” he said.
Dr Vali said that the patient was also put on certain anti-anxiety drugs to calm him during the procedure. “Sometimes the patient may land up into convulsions and swelling of brain could occur. In such situation we have to be prepared to put him on the general anaesthesia. The awake craniotomy decreases the cost of drugs heavily as no general anaesthesia drugs which are very expensive are used. It also puts the patient back on the feet immediately after the operation. This patient was very cooperative hence there were no hi-cups during the surgery,” she said,.
Dr Lokendra Singh, senior neurosurgeon and director, Dr M Taori Central India Institute of Medical Sciences (CIIMS) who has done quite a few awake craniotomy said, “It is heartening to see that awake craniotomy is being done in government set up. I laud the work of the entire team involved in the procedure. It does require a lot of skill of the surgeon as well as the expertise of the anaesthetists,” he said.
The team of anaesthetists led by Dr Vali included Dr Rajesh Nagmote, Dr Abhay Ganar, Dr Ketki Ramteke, Dr Neha Gedam and Dr Neha Shahane.
The case was presented in a CME on advances in neuro-anaesthesia organized by the department of anaesthesia, GMCH and SSH. The CME was inaugurated by Dr Rajshree Gandhe from Kokilaben Hospital Mumbai. Dr Vijay Shrotey, head anaesthesia SSH was the organizing chairperson.