Case Study : Awake Craniotomy For Brain Tumor

By Dr. Gurneet Sawhney, Neurosurgeon in Mumbai
Consultant Neuro & Spine Surgery, Fortis Hospital

I. Introduction :


The purpose of this case study is to highlight key clinical findings in a patient diagnosed with brain tumor affecting the speech area. The “awake” portion is what makes this technique unique and different from the standard asleep craniotomy. Due to the complexity of awake craniotomies, the procedure is very rare. Dr. Sawhney is highly trained in performing complex brain surgeries and has successfully performed a variety of parasellar tumor resections and craniotomies for more than fourteen years. Dr. Gurneet Sawhney, regarded as one of the best neurosurgeon in Mumbai for performing Microneurosurgery, Neuroendoscopy, and Minimally Invasive Spine Surgeries.




II. Abstract :


The current case study describes a patient with a large left frontal tumor in the speech area. Awake craniotomy is the appropriate technique for operating on such cases. When a tumor is near critical speech areas of the brain, it may be important to determine the exact location of these speech-related areas. Awake speech mapping may be carried out by applying mild electrical current to the surface of the exposed brain while the patient performs various tasks, such as reading, speaking etc. If the stimulation hinders the task, then that area of the brain is marked and preserved. Typically, the patients feel minimal or no discomfort while being awake during the surgery.




III. Diagnosis :


A large left frontal tumor in the speech area.




IV. Physical Examination and Tests :


Brain MRI, Functional MRI




V. Symptoms :


Focal seizures and word finding difficulty.




VI. Treatment and Prognosis :


Craniotomy is the only way to reliably preserve speech function during tumor resections, benefitting the patients undergoing such a procedure




VII. Case Presentation :


March 2020

Mr. Ramda Chopade visited the OPD with focal seizures and word finding difficulty. Brain MRI showed a large left frontal tumor in the speech area. Functional MRI was done which specifically defined the speech area and found that this area is involved with the tumor. Now the difficulty was to remove the tumor without affecting his speech. So I decided to remove his tumor while he is speaking to me. This advance technique is called Awake caraniotmy done at very few centers in the world. We took him to the operation and explained him the procedure. While operation we urged him to speak partial phrases and number counting and also showed him pictures so that he can name it. On stimulating partial areas in the brain he stopped answering our questions and we identified the actual speech area. I removed his complete tumor saving his speech. It was one of a kind surgery.




VIII. Post Operative Assessment :


Postoperation, patient found improvement. He got discharged in 3 days and happily spoke about about his experience.