Reprinted with permission,
Courtesy, Asbury Park Press, a Gannett Co. newspaper.
ASBURY
PARK PRESS
|
.
- Do
you remember being prepped for surgery and lying on the operating
table counting backwards from 10 as the anesthesia began to
take effect?
Somewhere between the numbers eight and seven you drifted to
sleep, no longer aware of what was going on around you. Then,
as if no time had passed at all, you were again awake and aware
of the surroundings. You recognized the voice of the neurosurgeon
asking if you could hear him.
What you should know about this scenario is that the surgery
was not over, it was just beginning.
An awake craniotomy, otherwise known as "awake surgery," is
an amazing procedure that seems almost unbelievable at first.
As the name implies, awake surgery allows the patient to remain
awake while his or her brain is being operated on.
The newest member of Monmouth Medical Center's Department of
Neurosurgery, Ty J. Olson, M.D., has brought to Monmouth a highly
effective new form of surgery to treat brain tumors and lesions
previously thought to be inoperable or only partially resectable.
Olson, who is one of only a handful of neurosurgeons in the
entire country to perform awake craniotomies adds, "Awake surgery
is a very useful technique when tumors are near eloquent areas
of the brain. Because everyone's brain is unique, anatomy can
only give us a general idea of where in the cortex certain critical
functions are performed, for example, the ability to comprehend
speech or move your right hand.
"When operating in or near vital locations of the brain, we
must delineate or "map' exactly where areas of eloquent cortex
are, so we can preserve them during our resection."
During awake surgery, the patient is asleep as the surgeon opens
the skull to expose the brain tumor or lesion and then awakened
from anesthesia for intra-operative testing.
Patients do not experience pain during awake brain surgery because
the scalp is numbed with local anesthesia and the brain tissue
does not sense itself.
Olson explains, "As the patient is awakened, we place electrodes
on the brain surface to record activity and stimulate different
areas of the brain. The stimulation deactivates, rather than
activates that small area of cortex. While the patient is performing
routine tasks, such as identifying pictures, moving his or her
hand, counting or answering questions, we stimulate discrete
locations to see how the patient performs with that part of the
cortex deactivated.
"If the patient is able to continue the task, we know it's not
a vital area, but if the patient has trouble with the task, for
example stops counting or slurs words, we know it is a vital
area that must be preserved."
While the notion of being awake during brain surgery can be
frightening at first, most patients like the idea of participating
in their own procedure and perform exceedingly well in the operating
room. Moreover, operating near vital brain areas with the patient
asleep under general anesthesia can be risky.
An area of tumor felt to be in vital tissue may be unnecessarily
left for fear of causing a neurologic deficit. Conversely, aggressive
resection without mapping may include areas of the cortex necessary
for speech or motor movement, leaving the patient with a neurologic
deficit and a decreased quality of life.
Olson said after awake surgery, a patient generally stays in
the hospital for two to three days. Most patients are able to
resume their normal activities in six to eight weeks.
"The results of awake brain surgery are excellent," Olson says. "Because
we are able to determine through electrodes and the patient's
own actions what areas of the brain are being affected, we can
better ensure we remove only the pathologic areas of the brain
and leave the healthy tissue intact. This technique allows us
to be much more aggressive with tumors previously considered
inoperable or too dangerous to resect."
Olson joins Monmouth Medical Center from the Neurological Institute
of New York at Columbia Presbyterian Medical Center where he
completed a six-year residency in neurosurgery and continues
to be on staff.
The Neurosurgery Program at Monmouth Medical Center specializes
in the diagnosis, surgical treatment and management of brain,
pituitary and spinal tumors. To learn more about awake brain
surgery or to contact Olson, call (732) 222-8866.
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