Breakthrough surgery in Bali

Andra Wisnu, The Jakarta Post, Denpasar | Fri, 01/09/2009 10:56 AM  

A 64-year-old patient remained fully awake during a successful surgical procedure to remove a malignant brain tumor, taking a phone call and all but reading the paper at Sanglah Hospital in Denpasar on Thursday. 

The man, Ketut Rimbang, became the first person in Bali to undergo an awake craniotomy, a procedure in which the patient remains fully conscious during the operation. 

As the one-hour surgery progressed, Rimbang waved greetings to doctors, tried to read the paper (though he had forgotten his glasses) and took a telephone call from a relative. 

"Hey, how are you? I'm in surgery right now so I'll talk to you later," he said smiling. 

About a week ago, Rimbang suffered from sudden paralysis. Family members thought he had had a stroke and took him to Sanglah Hospital where he was diagnosed with a tumor that was blocking the neuropathways of the brain that govern movement. 

Doctors are still waiting for lab results on the type of tumor, but they suspect it was malignant low-grade astrocytoma, a brain tumor that usually occurs in people between the ages of 40 and 60. 

Rimbang was too sedated to talk much during the surgery, though he said he felt no pain but was a little scared. 

The prospects of having his head opened and prodded by doctors sounded other-worldly, but an awake craniotomy is becoming an increasingly common procedure with important benefits. 

Neurosurgeons need their patients awake during for at least part of the surgery to monitor their brain function and use patient response as an assessment tool as they proceed. 

"This way doctors have the benefit of testing his critical motor skills such as moving and breathing," said Ketut Sinarja, the attending anesthesiologist. 

"It was quite a challenge because I had to make sure the anesthesia was enough to keep the procedure painless but at the same time keep him awake." 

Prominent people who have undergone awake craniotomies include US Senator Ted Kennedy and Indonesian celebrity Gugun Gondrong. 

It is not the first awake craniotomy in Indonesia, as similar procedures had been carried out in hospitals in Bandung, West Java, and in Semarang, Central Java, but doctors were happy that the procedure went well considering it was the first instance in Bali. 

As for Rimbang, he seemed calm after it was all over, smiling and raising his hand to give the V-for-victory sign.