A team of doctors from the “Bagdasar-Arseni” Emergency Clinical Hospital in Bucharest performed, in a first for the medical unit, a complex neurosurgical intervention to ablate a brain tumor, with the patient awake on the operating table.
The operation took about seven hours. PHOTO: archive
The patient is 20 years old and had been diagnosed with a large infiltrative tumor located in the left temporal lobe, an area of the brain responsible for speech.
In order to preserve his language functions, the doctors decided that part of the intervention should be carried out while the patient was conscious and able to communicate. During the operation, the young man answered the questions of the team psychologist and recognized images presented on a laptop, reports News.ro.
“I’m very well, I’m glad that I started to speak, after the operation the first three days I couldn’t speak, I couldn’t read, I couldn’t write anything and I’m glad that now I feel ok. I was able to speak during the operation, they showed me on the laptop. I felt ok, I had no emotions, I was curious how I would be awake during the operation. I can’t see well with my left eye even now, then I woke up in the hospital, really not I know where this came from. The family was happy that I got rid of the tumor. I was supposed to work at a courier company, I found out about the disease and I couldn’t do it anymore.” said Alin, the young man who underwent surgery.
The operation, which lasted about seven hours, was performed by a multidisciplinary team consisting of three neurosurgeons: asst. university Dr. Viorel Prună (primary physician), Dr. Ioana Petrescu (specialist physician) and Dr. Dan Visarion (resident physician, 6th year), four anesthesiologists: Dr. Robert Brânduş, Dr. Vlad State, Dr. Andreea Zamfir and Dr. Sonia Baciu, a clinical psychologist, Alexandra Avram, and a bioengineer, Simona Şerban.
“There was a patient with a left temporal brain tumor, a tumor that was located in an area responsible for speech, which is why it was decided to ablate the tumor with the patient awake. Practically, the surgical intervention had three major steps, in the first stage the patient was practically asleep so that we could reach the lesion. In the second step the patient was awakened, he was extubated, so that, through a technique new to us in the hospital, to be able to highlight the area responsible for speech. This was done through electrostimulation, we were able to stimulate the area responsible for speech. Once the area was identified, we were able to practically establish the upper border of the tumor from the area responsible for speech.” explained Dr. Viorel Mihai Prună, primary neurosurgeon.
The anesthesiologist Dr. Robert Brânduș emphasized the complexity of the procedure:
“It was a challenge, but with chances for this young man to have a normal quality of life now. Anesthesia with an awake patient has several steps, preparation before the operation is absolutely crucial, much more important than in other anesthetic situations, international protocols recommend us to go as far as knowing the patient as a personality, as well as passions, in order to be able to win him during the operation. We had the equipment, the technique we implemented, once awake, with the equipment that he helped us, the collaboration part with him intervened.”
The intervention was completed successfully, without incident during and after hospitalization, and the patient is in very good condition. The doctors say that he will resume his activities in a short time, without speech impairment.
Doctor Robert Brânduș explained what other complications could have occurred:
“Apart from epileptic seizures, it could be that he doesn’t like it, he doesn’t tolerate it, he gets agitated, he has a panic attack, something that the patient, being absolutely stuck in some screws, having zero mobility, and of hands and feet, waking up in an operating room, you might not like this thing. I talked to him, all of them, for days on end, before the operation I explained to him, a let’s be there, you’re going to hear our voices, we’re going to do this, and that was a challenge, intubated, detubated, pulling the doses into a fixed position.”
