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Awake Surgery to treat Brain tumours

The need for more awake surgery was made at a major conference on brain tumours in Dublin organised by the Irish Cancer Society. //

According to the Irish Cancer Society, in spite of the awake surgery being time-consuming and expensive, it has higher rate of success and any damge to the delicate tissue can be rectified. The National Cancer Registry’s recent data reveal that there were 316 new cases of primary brain tumour diagnosed in 2002.

The latest figures from the National Cancer Registry show there were 316 new cases of primary brain tumour diagnosed in 2002. Brain tumour claims approximately 213 lives every year.

Dr Michael Farrell, neuropathologist, Beaumont Hospital, said, “More staff have to be trained in the awake surgery technique and more funding is needed. “Awake surgery should be performed more widely especially in the resection of low grade tumours but at present we do not have the trained staff and because the surgery takes 25-50% longer, we do not have enough theatre time,” Dr Farrell said.

The demand for more neurosurgeons was also made, as there are only six consultants in Dublin and three in Cork. Awake surgery is a very common procedure in the U.S. whereas in Ireland, it has been done on a limited basis.

In this surgery, sedation is given to the patients initially and then they are woken up. Now, the neurological condition of the patient can be monitored as the surgeon removes the brain tumour. The surgeon needs the help of trained anaesthetic personnel and a psychologist or a neurologist to examine any complication that may occur during surgery.

When compared with the usual surgery, where the patient is completely anesthetized, awake surgery takes 25-50% more time. The latter is more expensive than the former. Dr Farrell said, “I hope this issue will be addressed when the HSE and Price Waterhouse reports on the development of neurosurgical se rvices here. “At present we have about half the number of neurosurgeons required and our waiting times are significantly longer than those in the US,” the doctor said. “When an urgent case presents, the other less urgent elective cases are also delayed. “We also have to account for the fact that in addition to treating patients with brain tumours, neurosurgeons also treat patients with brain haemorrhages, brain defects and disease, spinal tumours, head injuries and epilepsy.”

Mr Donnacha O’Brien, consultant neurosurgeon at Beaumont Hospital, said, “More has to be done to continue to improve survival times and quality of life for patients with brain tumours. “It is now appropiate to look at combining surgery, radiotherapy and chemotherapy to make a more aggressive treatment regime and conducting MRI scans during brain surgery which can help with maximisation of the resection,” he said.

The importance of MRI scans during brain surgery was emphasized at the conference. The complete removal of the visible tumour can be done with the help of MRI scan during the surgery. No intra-operative MRI scanner is available at either Dublin or Cork.


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