It was just another day for neurosurgeon KK Bansal as he asked his team to prepare for a surgical procedure at Narayana Multispecialty Hospital here. His patient, Hulasmal Jangir, a 30-year-old man from Bikaner, was to go under the knife which would remove a tumour from his head that had been giving him epileptic seizures.
Pleasantries were exchanged before the blinding light over the operating table was flipped on. One of the junior doctors assisted the anaesthetist, Pradeep Goyal, administer anaesthesia to Hulasmal. Two other doctors and three nursing staff looked on.
Dr Bansal made a neat incision on the left side of Hulasmal's skull. Now is when Hulasmal should have slipped into unconsciousness. But a nurse handed him a regional daily. As Hulasmal read the headlines out loud, and some news stories that caught his fancy, the surgeon was working upon him.
After a few minutes, as the patient grew weary of the news, he started reciting Hanuman Chalisa.
Over the next three hours, lying on the operation table, he chanted the religious text said to ward off trouble over and over. At the end of this, the medical team had successfully performed what Dr Bansal said was the state's first ever 'awake brain surgery' or awake craniotomy. The patient was completely in his senses the whole time, just as they would be in a dentist's chair.
Dr Bansal said: "Hulasmal was suffering from epilepsy seizures for the three months and biopsy results confirmed grade-2 brain tumour in the Broca area." It is the region in the frontal lobe of the brain's dominant hemisphere, usually the left, with functions linked to speech production. "This meant that the tumour was in the area of the brain which controls speech," the doctor said.
"So even a slight error during surgery would have led to a lifetime of speech impairment," he added.
Which is why it was important for Hulasmal to be awake and mentally active throughout the surgery, so doctors could observe his responses. Awake brain surgeries are used by select neurosurgeons across the globe to remove tumours located close to areas that control vision, speech and body movements.
"If the patient is sedated, like in conventional brain surgery, it is not possible to monitor their response. In awake brain surgery, the response can be continuously monitored, which helps the surgeon ascertain the exact spot without damaging other areas of the brain," Dr Bansal added.
"In Hulsmal's case, he was asked to read or sing throughout the surgery. His responses helped us perform the surgery successfully because whenever we would touch a wrong spot, his speech would get incomprehensible," Dr Bansal said.
Hulasmal said he was refused surgery at hospitals in Ahmedabad, Bikaner and Jaipur, where the doctors told him there was a huge chance he might lose speech and possibly get paralysed following an operation. He then came to Narayana Hospital, where the neurosurgery team successfully performed the surgery on him on November 14.
According to Dr Bansal, it was only the second awake craniotomy in the country, the first having took place in Bengaluru.
"Such surgeries can be performed at few centres in the country. We are happy that we could discharge the patient within 72 hours and he can now lead a normal life," said Karthik Ramakrishnan, facility director at Narayana Hospital.
‘Awake Brain Surgery’
- Hulasmal Jangir, a 30-year-old man from Bikaner, went under the knife to get a head tumour removed
- He was handed a regional daily from which he read the headlines out loud, along with some news stories
- While Jangir read the paper and recited Hanuman Chalisa, the surgeon was busy working to remove the tumour in Jangir’s head that had been giving him epileptic seizures
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