Awake during brain surgery

Open a patient’s cranial box to remove a tumor about 7 cm in diameter while the patient is awake on the operating table … This is the state-of-the-art surgical technique used by neurosurgeon David Fortin last week. Manon Bisson, a 37-year-old patient, also played the biggest role in her life. Indeed, she was awake and responded to the requests of her neurosurgeon while resecting her tumor.

E Does the surgery took place with great success since the patient of 37 years presented few motor and sensory deficit on awakening and it could fully recover in about a month.

“Neurosurgery on an awake patient stimulates areas of the brain to avoid significant sequelae and significantly reduces quality of life,” says neurosurgeon and neuro-oncologist David Fortin, who practices at the hospital. Fleurimont of the CIUSSS of Estrie-CHUS.

Manon Bisson learned that she had a brain tumor five years ago after having seizures, the first symptom she felt. Quickly, the first neurosurgeon she met wanted to operate. Asleep. But this mother of Gatineau was not ready. “I worked hard to preserve my health. I sleep well. I trained in nutritherapy to improve my diet. I do activities of all kinds to promote the neuroplasticity of my brain, “she says.

Moreover, when we look at this hyper-energetic woman, it is impossible to guess that in her brain lies a cancerous tumor about 7 cm in diameter.

Ready to do anything to face the disease with strength and courage by using as few drugs as possible, Manon Bisson asked a thousand questions. Watched and read well medical documentaries. Then she discovered Dr. David Fortin’s curriculum vitae a little over two years ago. “Dr. Fortin had great expertise in the type of tumor I had. I sent him an email to talk to him about my file. I wanted another medical opinion. Nine days later, I was sitting in her office, “says the mother of three, Cassandra, 21, Emrick, 18, and Louka, 8.

For the clinician and professor at the Universit√© de Sherbrooke who performs a dozen surgeries awake each year, there is a very clear line to avoid when he removes a brain tumor and waking surgery is the key, according to him , to avoid crossing it: “We must never neglect the quality of life of patients,” he insists.

“Neurosurgery on an awake patient can stimulate areas of his brain to avoid significant sequelae”
– Neurosurgeon David Fortin

As a researcher at the CHUS Research Center, the fight against glioma is at the heart of his career. These are primary brain tumors that are incurable – and it is precisely a glioma that has traced its path inside Manon Bisson’s brain.

Ready for surgery

The years have passed. Manon Bisson walked in her illness. At his side, Dr. Fortin was there to support and advise her. Then the date of March 13 was fixed. March 13 would be the big day. The day the neurosurgeon opened his cranial box to resect his massive brain tumor.

But the goal was clear from the outset for Manon Bisson and his neurosurgeon: it was necessary to resect the tumor without nailing a wheelchair this energetic woman with multiple passions.

To do this, one would have to resort to a surgery far from being banal: an awake surgery.

In Quebec, there are only three neurosurgeons, including Dr. Fortin, who operate while their patients are well awake on the operating table. Elsewhere in the world, the practice also exists but it is not widespread.

For anesthesiologists too, the challenge of this awake surgery is greater than in traditional surgery. First, all medications used must be carefully selected and dosed for the patient to collaborate with the occupational therapist’s tests.

Then, the complications, if any, may be more difficult to manage. For example, if surgery had triggered a convulsion like this can happen when the neurosurgeon directly stimulates the brain, the fact that the patient’s head is fixed to the table may not only cause injury but also makes security more complex. breathing and maintaining breathing when initially no intubation device is used.

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