In what may be hailed as a major milestone in the state's medical history, a neurosurgical procedure called 'Awake Craniotomy' or Awake Brain Surgery was performed for the first time in Assam at Hayat Hospital, Guwahati. The surgery was performed by our multi-disciplinary team of specialists under the supervision of renowned neurosurgeon, Dr. Arindom Kakati (MS, MCh), who is currently associated with us as a consultant neurosurgeon.
Awake craniotomy is like conventional craniotomy but here the patient remains awake during the surgery, and the surgeon performs a cortical mapping (identifying specific critical function areas of the brain) and constant evaluation of neurological changes. By conversing, asking questions and having the patient perform specific activities, the surgeon constantly monitors the patient's brain activities based on the person's responses. This type of intracranial surgery allows for effective mapping and resection of lesions in significant areas, and also reduces the risk of damaging critical brain areas that control motor and sensory functions like vision, speech, and movement.
Awake brain surgery is used to treat various neurological conditions like brain tumors, seizures, brain cancer and more commonly, epilepsy. Different techniques of performing this surgery are practiced; however, there are few things that are uniformly relevant for all.
- Monitored Anesthesia Care - Monitored administration of anesthesia according to the stage of the surgery so as to facilitate patient cooperation and to maintain the level of analgesia and anxiolysis.
- Patient Comfort - Since the patient will be awake for a long time, there should be maximized care meted out to ensure the person is comfortable and feels no pain.
- Nausea Prevention - Prevention of nausea and vomiting is highly important as this may increase intracranial pressure.
- Capnography - The monitoring of concentration/partial pressure of carbon dioxide (CO2) in the respiratory gases.
- Hemodynamic and Respiratory Stability - Extremely important since the patient keeps transitioning between sleep state and awake state, and complications related to various parts can emerge.
Awake craniotomy has been prevalent for a long time but isn't performed very frequently, especially in the Indian context. This is because it is a complex procedure and there are challenges involved, both for the patient and the medical team. As such, high level of skill and experience on the part of the medical team; especially the neurosurgeon and the anesthetist is required.