Queen Elizabeth II Hospital Performs Sabah’s First Awake Brain Surgery

In an historic first for Sabah, Queen Elizabeth II Hospital performed an awake craniotomy procedure last Jan 12 on a 50-year-old female patient with multiple brain tumours, who spelled names and sang a song while awake and alert during the brain surgery.

KUALA LUMPUR, Jan 17 – Queen Elizabeth II Hospital (HQE II) has performed the first awake craniotomy procedure in Sabah on a 50-year-old woman with multiple meningioma who was awake and alert throughout the brain surgery.

The awake brain surgery was carried out in the public hospital in Kota Kinabalu last January 12 by HQE II neurosurgeons Dr M. Sofan Zenian and Dr Hezry Abu Hasan, together with neuroanaesthesiologist Dr Yeap Boon Tat from Universiti Malaysia Sabah (UMS) and consultant neurosurgeon Dr Liew Boon Seng from Sungai Buloh Hospital.

“Awake Surgery involves advanced techniques of awakening the patient in middle of surgery to test their brain functions to ensure no damage is done to sensitive areas during surgery such as speech and movement,” Dr Hezry tweeted yesterday.

“Only a few places in Malaysia can conduct this surgery as you have to keep the patient fairly alert and cooperative but pain free during surgery.”

Sabah state health director Dr Rose Nani Mudin said in a statement last Sunday that awake craniotomy, which has been introduced worldwide since the early 2000s, was first conducted in Malaysia since 2010 in Universiti Sains Malaysia Hospital (HUSM), Kuala Lumpur Hospital (HKL), Sungai Buloh Hospital, and Sultanah Aminah Johor Bahru Hospital (HSA).

“Preparations and close discussions between HQE II, Duchess of Kent Sandakan Hospital (HDOK), and UMS were started since November 2022 for this surgery,” she said.

The awake brain surgery patient in HQE II was a 50-year-old woman who was diagnosed in HDOK with multiple meningioma in the left side of her brain, after suffering headaches since October 2022. Her clinical condition and symptoms were deteriorating until it affected her quality of life.

Meningiomas are the most common benign intracranial tumour. Most patients develop a single meningioma; however, some patients may develop several tumours growing simultaneously in other locations of the brain or spinal cord, according to the American Association of Neurological Surgeons.

“In awake craniotomy, the patient remains conscious throughout the surgery. The neurosurgeon will constantly monitor the level of consciousness and brain activity from time to time throughout the procedure,” Dr Rose said.

“This is important so that the neurosurgeon can evaluate the effectiveness of the surgery and potential side effects that may pop up like bleeding in the brain. Therefore, close cooperation between the neuroanaesthesiologist and the neurologist is needed throughout the operation.

“Examples of patients who can benefit from awake craniotomy are those with growth in the brain, cerebral aneurysm, and bleeding in the brain (extradural haemorrhage and chronic subdural haemorrhage).”

The Sabah state health director also pointed out that the HQE II awake brain surgery involved the technique of conscious sedation, the first in Sabah, where the neuroanaesthetist provides sufficient anaesthetics to the patient but not too much until it induces sleep.

“The infusion of drugs requires a special machine called target controlled infusion that measures the concentration of the drug in the patient’s blood. Patients who receive anaesthetics while conscious can communicate with their doctor throughout anaesthesia.”

Dr Rose said that general anaesthesia is typically used during brain surgery by inserting a breathing tube into the patient, but in awake brain surgery, a breathing tube isn’t necessary as the patient’s breathing is not disturbed.

“This awake craniotomy procedure took six hours with the patient remaining conscious,” said the Sabah state health director.

“Throughout this operation, the patient could spell names and sing a simple song. After the surgery, the patient only experienced a mild headache and could drink water and eat soft food the next day.”

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