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Brain surgery while patient is awake

Awake craniotomy is a type of operation done to treat conditions such as brain tumours or epileptic seizures while the patient is awake.

Neurosurgeon Ivan Ng, who has his own practice in Mount Elizabeth Novena medical centre, said it is applied especially when the tumour is near the parts of the brain that control movement or speech.

"Keeping the patient awake during surgery will help him respond to the surgeon's instructions. This helps ensure that while operating, we treat the precise area that needs the operation. It also lowers the risk of damage to its functions," he said.

Director of the Surgical Neuro-oncology Programme at the National Neuroscience Institute (NNI) Ng Wai Hoe said his team performs awake brain surgery "very regularly".

"I have done more than 100 cases. Probably at least one a month," he said.

"The whole premise is to monitor critical function such as movement and speech, preserve these functions while pushing surgery to the maximum and remove as much of the tumour as possible without destroying the brain function," he added.

Dr Ivan Ng, who has 15 years experience in his field, said: "We map out the critical regions of the brain accurately to minimise the risk of damaging important areas.

"During the procedure, the patient is guided through a series of instructions or asked to respond to questions. We then resect as aggressively as we can and as fast as we can."

He said that in brain operations to remove embedded tumours, the chances of paralysis is between 30 and 50 per cent, if the patient is not awake to respond to the surgeon's instructions.

"Awake craniotomy reduces the morbidity by 2 to 3 per cent," he said.

Dr Ivan Ng said he has to select patients carefully to make sure they are right for the procedure.

"It is absolutely critical they understand the surgeon, able to follow instructions and are not too old. That's why I often have 'dress rehearsals' with my patients before the actual operation so that they understand the whole procedure," he said.

In Canada and Britain, the procedure is carried out as day surgery, but this is not encouraged at NNI.

"But we had one exception because the man's wife was going to give birth and he wanted to be there for the birth of his child," said Dr Ng Wai Hoe.