Mon, Mar 08, 2004 - Page 6 News List

Patients with brain tumors kept awake during operation


Patients with a rare form of brain tumor are being kept awake during a lengthy operation so that they can talk to the surgeon and help ensure their speech faculties are not damaged.

The pioneering surgery is carried out under a local anesthetic to the scalp so that patients feel no pain. They remain fully conscious and communicative while the doctor removes tumors that have become embedded deep within the brain.

The surgery, known as awake craniotomy, has been performed occasionally on epileptic patients but very rarely on those with brain tumors. Now the technique is being used on such patients as they might otherwise have a much shorter life span.

A BBC television documentary to be screened today shows 30-year-old Adrian Theobald being diagnosed with a low-grade glioma -- a benign tumor that would nevertheless kill him through its growth without surgery.

His neurosurgeon, Henry Marsh, is the only doctor in Britain to perform the procedure for patients with these tumors. When Marsh first diagnosed the condition last autumn he had to warn Theobald that there was a risk in cutting so deep into the brain to remove as much of the growth as possible: the parts of the brain which govern speech, language or personality might be affected.

The documentary followed the fortunes of Theobald, who survived the procedure despite falling into a coma after the surgery. During the four-hour operation he had the top of his skull removed and Marsh then started to remove as much as possible of the 6cm-long growth because it was pushing dangerously into the left frontal lobe near the speech area of his brain.

As parts of the tumor were removed they were given to pathologist Peter Wilkins who carried out an immediate biopsy to ensure that it was tumor rather than healthy brain tissue which was being excised. Sometimes the tumor is too close to the other parts of the brain to know which kind of tissue is being cut out.

Marsh said the issue of awake craniotomy is "very controversial."

"I have a fairly aggressive approach in trying to remove as much of the tumor as possible. I have to make a decision about what to recommend to patients, without having any clear body of evidence to guide me. I believe that this is the right thing to do."

Although there are American surgeons who carry out the same procedure, one surgeon in Paris, one in Munich and Marsh in London do the bulk of such surgery for the whole of Europe.

At his clinic at St. George's hospital in south London, Marsh has around 100 patients but will carry out one of these operations a month.

"The difficulty is that you are operating very close to the regions of the brain that affect people's thoughts, feelings and speech. It could change their personalities forever," he said.

"You have to tell patients all the possible dangers -- but provided it is not prohibitively dangerous, I feel the work is justified."

Theobald, an insurance broker from south London, has recovered well, after Marsh managed to remove 98 percent of the tumor. He was not available for comment this weekend.

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