Scary but incredible: UAE patient recalls having brain surgery - while awake

Jogin Augustine had tumour removed at a hospital in Abu Dhabi

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A patient has spoken about having brain surgery while awake.

Jogin Augustine, 41, had a tumour removed from a “tricky” area that controls speech.

Mr Augustine, from India, was originally treated for brain cancer in 2014 by surgery, radiotherapy and chemotherapy.

But the cancer returned recently in a complex location near to the original site, in the front left area of the brain which governs speech production and articulation.

It could not be done as a conventional brain surgery, where we go in and chop the area, because otherwise we would have sacrificed his speech
Dr Mohammed Asha, Tawam Hospital

That left doctors with no choice but to operate in late July via awake craniotomy, which is an established procedure in countries like the UK.

In such procedures, the patient is awake but sedated, allowing neurosurgeons to remove tumours that would otherwise be inoperable because of the growths being too close to areas of the brain that control vision, language and body movements.

The operation, which was performed at Tawam Hospital, a part of the Abu Dhabi Health Services Company (Seha), has greatly improved Mr Augustine's prognosis and improved his ability to function, allowing him to resume his normal life.

He will return to teaching in November.

“It could not be done as a conventional brain surgery, where we go in and chop the area, because otherwise we would have sacrificed his speech,” said Dr Mohammed Asha, consultant neurosurgeon at Tawam Hospital, who had performed the surgery many times in the UK and Canada, where he used to work.

“He would be mute or talking gibberish at best. So we did it awake.”

Mr Augustine, a schoolteacher who lives in Al Ain, said it was a scary, but also an incredible experience.

“I still remember what he asked me during the surgery,” he said. “He asked me some questions, like what is this, such as a giraffe and an elephant. What do they eat?”

But keeping the patient awake and pain-free was complex.

“When he was having the surgery, my role was to keep him awake to be able to respond to the surgeon when the surgeon asked him to raise his arms and wiggle his toes, say this, say that,” said Dr Osama Mahran, consultant neuro-anaesthetist at Tawam Hospital, who performed the anaesthesia.

“It’s very complex. It needs a lot of training and a mix of medications. You are talking about tens and tens of different drugs. Your role as an anaesthetist is to be able to mix and match these.”

Dr Asha used a probe that discharged tiny electric signals that Mr Augustine was not able to feel, but they affected the function of the area he was testing in the brain.

Any time he touched the speech centre, Mr Augustine was prevented from speaking.

They did that over and over, using several exercises during the operation, such as counting to 10 and naming pictures, to make sure they were removing the tumour, not tissue from the speech area.

“By doing this we were able to pinpoint exactly where the speech area was,” Dr Asha said.

“A tiny proportion of the tumour inside the speech area wasn’t removed. But everything else in the speech area that does not affect his speech was removed.”

Updated: September 16, 2021, 3:34 PM