"I played the piano for at least 6 hours, I also played mobile games. I feel better now.”
When the parents of nine-year-old Soumeya first brought her to the Birla Hospital in the city of Gwalior in India's Madhya Pradesh province, doctors soon realized that she had a dangerous brain tumour that would require major surgery for removal. To reduce potential damage to other parts of the child's brain affecting vision, movement, or speech, the doctors decided that an Awake Craniotomy procedure would give them the best chance for success.
First pioneered by Canadian neurosurgeon Wilder Penfield in the 1920s for the treatment of epilepsy, an awake craniotomy involves the removal of part of the patient's skull to allow surgeons to operate directly on the brain while patients are awake and able to communicate with the surgical team. Given the potential risk of accidentally damaging nerve tissue in other parts of the brain, the surgical team used a local anesthetic to numb pain only in the part of the head where the surgery was being performed. As for surgery on the exposed brain itself, no anesthetic is needed as the brain has no pain receptors. Along with being an extremely difficult procedure, an awake craniotomy also requires extraordinary cooperation among all the members of the surgical team, including the neurosurgeon, neurologist, and anesthesiologist.
Monitoring a patient's mental functioning during the operation often involves having that patient engaging in familiar tasks, including playing a musical instrument or doing mental exercises or video games. Knowing that Soumeya enjoyed playing music on a synthesizer, the surgical team decided that having her play would allow them to monitor her mental functions during the course of the lengthy operation. “The case was challenging but the operation was successful with our team’s efforts," said neurosurgeon Abhishek Chauhan . "When we were operating we asked her to play the piano. There were chances for the child to slip into paralysis but she was conscious throughout the operation.” Initial reports indicate that the surgery was a success and Soumeya is expected to make a full recovery.
Though common in North America since the 1980s, the use of awake craniotomies have since spread to Europe and across Asia. The procedure is expected to become more widely used in Asian hospitals given the number of potential patients that can be helped and better recovery time compared to less radical methods. While not all awake craniotomy patients are expected to serenade their surgical team with music, staying awake during these operations allow patients to preserve physical and mental functions that they consider vital and to return to their normal lives as quickly as possible.
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