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Awake Brain Surgery: The story of a young patient

On the morning of June 26 this year Mahipal Solanki, a 25-year-old home appliance entrepreneur lay on a bed, relaxing over his favourite Bollywood numbers. Hovering over him were faces covered in blue surgical masks, their deft fingers working inside his brain, removing deadly cancer cells. “I couldn’t feel any pain,” says Solanki with audible cheer. “I could see doctor Venkataramana and his team of doctors around me, removing the tumour even as Kumar Sanu sang in the background, his mellifluous voice mixing eerily with the clinical quiet of the surgical theatre. But there was no pain, just a very odd feeling knowing that my head had actually been split open and I was still not only alive but conscious, talking to the doctor like normal!”
Four years back, on June 27, minutes after Mahipal had finished with a series of elaborate ceremonies that form a traditional Gujarati wedding, he collapsed to the ground with a bout of fits. “Everyone around me thought that it was owing to exhaustion as it had been a long day, packed with ceremonial engagements,” recalls Solanki.

But his headaches only got worse and more frequent. A month later, he suffered from another attack of fits, which is when he decided to see Dr Suresh Hegde in Bangalore’s Mallya Hospital. An MRI revealed a brain tumour. “Glioma, I was told” says Mahipal. “Until then I had not even heard of the word, glioma.” When he and his family understood what it was, the first reaction was one of shock and disbelief. “How could this be true?” So, “we went to a doctor known to us in Hubli for a second opinion.” He confirmed the diagnosis. There was no doubt that “I was suffering from brain tumour,” says Mahipal, now the father of one-year-old Dhriti.

The verdict carried a morbid finality. We were stunned, says Mahipal. But his newly-wed wife took the news with extraordinary poise and courage making no public show of the grief she clearly felt. “It was her attitude and my father’s support that helped us in turning the corner. We were soon talking solutions; we decided to stand up and fight the disease.”

In December 2012 the Solankis met Dr Venkataramana, eminent neurosurgeon and director of Global Institute of Neurosciences. Soon thereafter, Mahipal went through his first surgery at the Hospitals in Bangalore. “I felt fine after that,” he says. “The care was exceptional.” But in April 2015, the fits returned and Mahipal was back in Dr Venkataramana’s consultation room. Tests revealed that the glioma had re-surfaced. “That is when the doctor recommended awake brain surgery to me,” says Mahipal. “Initially, it was an unnerving, scary thought and I said no.”

Later, however, after the doctor counselled him on the particular advantages of the procedure for him, Mahipal agreed and here he was on a surgical bed, his head open, listening to music and speaking to the doctor casually alongside a brain surgery! It has been more than two months since Mahipal went through awake brain surgery and he says that he never felt better in his life.

Also called intraoperative brain mapping, awake brain surgery is a procedure that enables neurosurgeons to remove tumours that would normally be inoperable because they are too close to critical regions of the brain responsible for critical functions like vision, language and body movements. “Without awake brain surgery removing such tumours would be unacceptably risky,” says Dr Venkataramana.

Neurosurgeons perform awake brain surgery for tumours that have spread throughout the brain and do not have clear borders, such as some types of glioma.

For the procedure, Mahipal was sedated and his scalp numbed. “Working closely with a neuroanesthesiologist, we decide whether awake brain surgery is an appropriate choice for a particular patient, depending on how effective we think it would be in helping us remove a tumour without damaBRAINSg critical parts of the brain,” says Dr Venkataramana. “We assessed Mahipal’s general health and whether he would remain calm and responsive during the procedure.”

In awake brain surgery the patient receives a local anaesthesia to numb the scalp at the beginning of the procedure. The sedation is stopped when the neurosurgeon is ready to remove the brain tumour. Finally the neuroanesthesiologist sedates the patient again towards the end of the procedure.

The surgery itself involves stimulating regions surrounding the tumour with small electrodes with the objective of locating the brain’s functional areas that must be avoided. To keep patients calm and ascertain the limits to which it is possible to go without causing functional damage, neurosurgeons engage them in conversations throughout the surgery asking them to perform several tasks. “The doctor encouraged me to keep talking and asked me repeatedly to clench and open my left fist and flex my left knee throughout the surgery,” says Mahipal.

Says Dr Venkataramana, “this helps us remove as much of the tumour as possible (if not all of it) while avoiding the functional areas of the brain.” Mahipal is now back on his feet busy with his family business that he entered when just 19. “I am thankful to my family, Dr Venkataramana and of course most importantly god for having come this far,” says a relieved Mahipal.

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