September 25, 2007 – The world’s first patient to undergo brain surgery while conscious and speaking to his doctors during the procedure said it was odd to hear the doctors talking to each other as he lay on the operating table with a half-an-inch hole in his head.
John James, 78, spoke about his experiences at a press conference Sept. 24, at the Canberra Hospital in Australia. He said he was confident in his doctors and did not worry during the procedure.
He was asked to read the words and numbers on flashcards shown to him during the surgery so his doctors knew if they were affecting his vision.
James was suffering from a life-threatening venous aneurysm behind his right eye. Doctor’s discovered the aneurysm after he sought medical attention because of vision problems and blackout spells. Due to its location and the possibility the surgery could cause him to go blind, the decision was made to perform an awake craniotomy.
The surgery was successfully carried out April 26, and was the first formal awake craniotomy program in Australia or Asia for a patient with advanced blood vessel abnormalities.
Doctors said the patient no longer needed his glasses following the surgery and maintains a healthy, active and independent lifestyle.
Dr. Vini Gautam Khurana carried out the operation. He is a Mayo Clinic-trained, Australian neurosurgeon with an advanced neurosurgery Fellowship in cerebral vascular and tumor microsurgery from the Barrow Neurological Institute in Phoenix, AZ.
Dr. Khurana said virtual reality software was used to create a three-dimensional image of James’s brain. This allowed the team to practice the procedure. The 3-D images were also projected on one side of Dr. Khurana’s eyepiece as a reference during surgery. On the other side were projected close-up views of the brain through a microscope.
The team also used an ultrasound probe to make sure no more blood was flowing through the aneurysm after it was drained.
The patient was only awake for 45 minutes during the four-hour operation.
Doctors said James was not intubated, but was comfortably oxygenated and asleep while the local anaesthetic blocks were being administered to the scalp and back of the upper neck.
The procedure is only for select patients with tumors or vascular malformations in highly functionally important parts of the brain. Dr. Khurana and his team offer the specialized awake brain surgery to obtain as complete a resection as possible while having the patient awake, pain-free and comfortable and neurologically testable during only the critical parts of the surgery. For all other parts of the operation, the patient is kept asleep. The team says in the select few chosen for this type of surgery, being awake during the critical part of the operation can make a very positive difference to the outcome, as the neurosurgeon can be more aggressive with the condition knowing the patient is awake and responsive and neurologically intact as the tumor removal or resection proceeds while the patient is being functionally tested by other members of the team.
The procedure is recommended for patients who can tolerate the concept of undergoing some part of the neurosurgical procedure in a fully awake state; they have a condition such as a brain tumor or vascular malformation that is located in or very close to a highly functionally important part of their brain; and if the performing neurosurgical team is experienced and comfortable with such an approach.
The Canberra Hospital is a public hospital located in Garran, Canberra. It is a tertiary level centre with 500 beds and caters to a population of about 52,000. It is the major teaching hospital for the recently established Australian National University Medical School. It is also a teaching hospital for the University of Canberra's School of Nursing. It also has strong links with the John Curtin School of Medical Research.
For more information: www.brain-surgery.net.au