Staying awake as your brain is opened

Keep opening and closing the fist of your right hand we are almost done removing the tumour I told Ali raising my voice more than usual to bypass the beep of the monitors I was operating on his gently pulsating brain while he was completely conscious Youre doing great stay with me for a little longer and keep clenching and releasing your fistI spoke to him constantly while peeling off the last bit of the grey tumour that clearly stood apart from the glistening healthy white matter of the brain Wallah he gasped as he turned his gaze and saw the sight on a screen in front of him directly relaying the video of what was under the microscope Arise awake and stop not till the goal is reached I remembered Swami Vivekananda as we achieved what we had set out to doAli was a 50yearold affluent Omani businessman with a degree from Harvard His colon malignancy had shown signs of metastasizing into the brain Over the past few weeks he had noticed a slight clumsiness in his right hand and the scan showed a 35 cm ball of cancer straddled between the left premotor and motor cortexmdash the area of the brain responsible for movement of the right handWhen I had first examined him a few days prior and discussed the nature of his problem I explained that since the tumour was in a critical location responsible for hand function we could remove it while he was awake as we continuously tested his hand That way if he developed even a subtle weakness wed stop excising the tumour to preserve functionWill I feel any bain was his first question Arabs dont enunciate the POnly betite I said hinting at little showing him a tiny gap between my thumb and index fingerYou see I continued the only thing in the head that feels pain is the scalp which covers the skull bone And the covering of the brain These we will numb with local anaesthesia The brain itself feels no pain and yet all the paingenerating centres are smack within itAnd its this that makes the organ the last and grandest biological frontier the most complex thing we have tried comprehending in the universe I am fascinated by the infinite potential of this threepound jelly mass that we as neurosurgeons have the unprecedented joy of seeing daily and yet know so little about Early in its history awake craniotomy or the opening of the skull to access the brain while the patient was still conscious was used for the treatment of epilepsyArchaeological records indicate that in ancient times patients were treated for seizures by trepanation drilling holes in the skull to let out evil spirits and cure them of their inflictions Centuries later we have come full circle refining the technique a wee bit In India we began using this technique in the early 90sWhen tumours involve the speech and language portions of the brain we need patients to talk to us throughout the procedure they read name comprehend and repeat tasks shown to them on an iPad as we test all modalities of language One such patient got so tired doing this when the time came to remove the most critical part of the tumour he fell asleep We had to wait till he was awake and agreed to cooperate againThere have also been some uplifting stories of musicians who have been asked to perform while in surgery to ensure that their playing ability remained unharmed AmbroAringfrac34 BajecLapajne a Slovenian operatic singer diagnosed with endstage brain cancer performed two couplets from Franz Schuberts Gute Nacht during an awake craniotomy in 2015 at a Dutch clinic This I believe goes perfectly with what AmericanHungarian conductor George Szell once said In music one must think with the heart and feel with the brainThe writer is practicing neurosurgeon at Wockhardt Hospitals and Honorary Assistant Professor of Neurosurgery at Grant Medical College and Sir JJ Group of HospitalsCatch up on all the latest Crime National International and Hatke news here Also download the new midday Android and iOS apps to get latest updates