DUBAI // Patient response is vital during complicated brain surgery as it reduces the risk of damaging important body functions.
That is from the man pioneering the widespread use of “awake” brain operations in the UAE.
This type of surgery is rare, especially in the Middle East, but offers many advantages, said Dr Ahmad Bitar, a neurosurgeon and head of the brain tumours and vascular neurosurgery unit at Dubai’s Neuro Spinal Hospital.
People who have tumours near functional tissue – the parts that control movement or speech – and whose conditions may have been considered inoperable, can benefit from this surgery with a minimal risk of damage to brain tissue.
Being awake allows the patient to respond to the neurosurgeon to help ensure that the precise area of the brain is being treated.
The process is called functional brain mapping, said Dr Bitar, who began performing the procedure in the UAE last year and believes he is the only doctor in the emirates to do so.
He has carried out six such procedures, to date.
“The principle of this surgery is the very different placement of functions in the brain in each patient,” Dr Bitar said. “We need a functional map of this patient.
“Having this functional map during surgery helps us localise the function areas. This means the areas for movement, for speech, for memory, counting, reading and writing – all of this.
“To do this we need the help of the patient. When he is anaesthetised, how can we test the patient?”
While a preoperative scan can help, finding functional brain tissue is not an exact science, he said.
The patient is given a local anaesthetic and sedated. Then, coaxed into consciousness, the patient is encouraged to perform some simple tests.
This allows the neurosurgeon to pinpoint, using electrodes, which areas of the brain are responsible for a particular function.
“It means we ask him to move the hand, to count, to read, to write, to repeat some sentences,” Dr Bitar said.
“During these tests we stimulate the brain. We block the function. It means you will see the patient moving the hand or the finger and when I stimulate the area, the region which is responsible for this movement – it will block it.
“So I know this area is responsible for the movement of the hand.”
Another test is for the patient to count to 10.
“When I block this area he will say ‘four’ then he cannot say ‘five’, so I know this area is responsible for counting.”
Brain mapping, along with 3D computer images, helps the neurosurgeon remove as much of the brain tumour as possible and reduces the risk of damaging important body functions, said the Finnish expatriate.
Functional brain mapping is a long procedure and can take hours, depending on the location and size of the tumour.
Unfortunately, there are very few brain tumours neurosurgeons can actually cure because many regrow.
“The cancer is a cancer,” said Dr Bitar, and not often curable.
But it can improves the lifespan and quality of life for the patient.
The long-term outcome depends on the type and grade of the tumour, but awake brain surgery allows the neurosurgeon to safely remove more of it than if the patient was asleep.
The more of the tumour neurosurgeons remove, the better the outcome.
Awake brain surgery can allow a neurosurgeon to remove between 90 and 98 per cent of the tumour with reduced complications, he said.
“If we remove 50 per cent of the tumour, even 80 per cent, the mean of survival is not very long. But if we can remove more of the tumour we get better survival and better quality of life for a patient,” Dr Bitar said
jbell@thenational.ae
