Page 22 - Christiana Care Focus April 2019

Neurosciences |
Neurosurgeons perform first awake brain surgery in Delaware
Procedure allows special sensitivity to speech and communication
Graham Cancer Center colleagues led the first awake brain surgery in Delaware. From left: Jeremy McCallister, Au.D., DABNM;
Debra A. Dibert, BSN, RN; Kristen Palmer, MA; Leif-Erik Bohman, M.D.; Pulak Ray, M.D.; Britney Walker, PA-C; Jessica Bahls, MS, CCC-SLP; Jamie DiCicco, MS, CNIM; and Eileen Christie, BSN, RN, CNOR.
In a procedure performed in Delaware for the first time, Christiana Care neurosurgeons Pulak Ray, M.D., and Leif-Erik Bohman, M.D., conducted brain surgery while their patient was awake and talking with them.
The procedure, called an awake craniotomy, has a long history of use for different conditions, but was performed for the first time in Delaware to treat a brain tumor.
Awake brain surgery was essential in this case because the patient’s tumor, called a glioblastoma multiforme, was pushing on centers that control speech and language comprehension, causing problems with speech. Surgeons needed the patient awake and communicating to guide them physiologically in order to protect and preserve those critical functions.
“Our ability to perform awake craniotomies at Christiana Care makes it possible to treat brain tumors in sensitive regions where surgery may not have been possible
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previously,” Dr. Ray said. “Awake brain surgery can allow better outcomes and less damage to healthy brain tissue.”
A team approach
Among the multidisciplinary team of experts involved in the procedure were speech pathologists, intraoperative neuromonitoring specialists, specialized neurosurgical nurses and anesthesiologists under the guidance of Christiana Care anesthesiologist Sophia Cisler, M.D.
“For an awake patient to feel comfortable in the operating room environment, we also must incorporate very careful and strategic sedation medication,” Dr. Cisler explained. “This is particularly important in a
craniotomy procedure, where close control of the patient’s breathing, blood pressure and heart rate are essential for safety.”
Recent advances in intraoperative brain- mapping technology and the evolution
of more sophisticated anesthetics have opened new possibilities for treating infiltrating brain tumors like glioblastomas that are difficult to remove.
Using advanced imaging guided navigation, the team created a detailed map of
the patient’s brain and confirmed the functional location of speech centers
using a technique called direct cortical mapping, where electrical discharges are systematically delivered to the tumor bed and surrounding brain tissue.