Double “awake” brain surgery milestone for Mediclinic Milnerton

Posted on 4 June 2019

Mediclinic Milnerton recently played host to two cases involving a surgical procedure referred to as an “Awake Craniotomy”.  As the name suggests, the patient is awake during the surgery to remove a tumour from their brain. Initially, both patients presented with headaches and symptoms suggestive of a stroke, and were later diagnosed with malignant brain tumours or Glioblastomas.

Dr Zahier Ebrahim, the neurosurgeon who performed both surgeries, said that while this procedure was not rare, it was the first time it had been performed at the Mediclinic Milnerton. It was also unusual to perform two in as many weeks.

“It just so happened that we were presented with two patients with tumours involving parts of the brain close to centres of speech and movement in a short space of time. Performing the operation to remove the tumour while the patient is awake allows us to test these ‘eloquent’ regions of the brain before we cut into them or remove them, while monitoring the patient’s function throughout the operation,” Dr Ebrahim explained.

He added that the overall aim was to minimise the risks of the operation, while preserving as much of the patient’s speech and movement as possible. Both patients, a woman (41) and man (51) are doing well following the procedure.

When discussing the actual ‘awake surgery’ Dr Ebrahim explains that each procedure can take anywhere between 4 – 6 hours but this may be longer depending on the tumour size, location, surrounding structures, tumour consistency. “A lot of time is spent on patient positioning and theatre setup ensuring complete patient comfort and ease on awakening from anaesthesia during the procedure,” he explains.

The surgical risks are similar to conventional surgical approaches but because of the use of intra-operative cortical stimulation, there is a higher risk of intra-operative seizures. Other risks include severe cerebral swelling, cognitive deficit, speech and motor deficits, visual disturbance and meningitis. As one can imagine, the anaesthetic risks with awake surgery are significantly different. The pain control and airway management are critical to the success of the procedure. These procedures require extensive planning, preparation and correct patient selection and we rely on input from all the members of the team to achieve a successful outcome.

According to Dr Ebrahim surgery is not the end of the treatment plan, “Malignant brain tumours are associated with a poor prognosis. The median survival for Glioblastomas is 6 months and there is a 10 % survival rate at 2 years from diagnosis. With maximum therapy including gross total resection, radiotherapy and chemotherapy we aim to improve survival by 12 – 18 months.” As a result, radiotherapy and chemotherapy are critical components of patient treatment following the surgery.

“It was very much a team effort, with everyone involved – the surgeon, the anaesthetist, speech therapist, occupational therapist and nurses – crucial to the success of the operations. The success of both procedures is a testament to professionalism, teamwork and the cutting-edge facilities available at Mediclinic Milnerton,” Dr Ebrahim said.


Published in Innovation