Consulting the patient

We’ve been talking about an operation for your brain tumour. I think it’s clear that we feel there’s an indication to remove the tumour, using an operation. But you’ve mentioned that you have language disturbances, episodes of language disturbance. And this shows us or tells us that the tumour is in an area of the brain that is involved in language. And we feel it may be possible to perform a procedure, in which we also test the language. So as to monitor to function during the operation and possibly be able to preserve the function better, as opposed to an operation under general anaesthesia. So I would like to talk to you about this possibility of waking you up during the procedure.

And I’ll tell you about this method and its possibilities. The benefits of the period of being awake, which are that if you’re unconscious, he has to be very careful in what he removes of the tumour, whereas if you’re conscious and we can test all the different areas, then more of the tumour can be usually be removed, because he knows which areas are important and not for the speech. Now I’m sure you can imagine, it’s not nothing to be awake during surgery like this with your brain exposed. So our role is to help you through this. And the first bit of the surgery, you’ll be under general anaesthesia.

And when you do that, when you’re under anaesthesia, we’re going to do all that we can to make sure that the later phases are more comfortable. So after you’ve lost consciousness, and we’ve controlled your airway and put in an airway device, we’re going to inject local anaesthetic all around your scalp to stop all the nerves from working. So this means, later when you regained consciousness and the surgeon’s operating, we don’t expect any pain from what he’s doing. If there is discomfort, you let us know. Now the surgery itself shouldn’t be painful. But the thing is that lying still for so long is very unnatural.

Normally, when you sleep, you move every 20, 30 minutes, whereas during the surgery, you can’t move. If you need to cough, you need to tell us. The surgeon needs to stop, et cetera. So lying still, your muscles and joints really start to ache after some period of time. And this could last for several hours. You need to focus. You need to be working with the neuropsychologist and concentrating on not moving. So it’s a really difficult and long time. And you need to prepare yourself, psychologically, for it. We think that you’re the kind of person that can cope with this stressful situation. We’ve got every confidence in that. And we’re also all there as a team, working with you.

You’re a member of the team. You’re in the centre of the team, really. And you’re helping to facilitate the surgeon to do as good an excision or removal of the tumour as he can. You’ll be lying in that lateral position, with your right arm fixed to the armrest. And you can move your left arm freely. And I’ll be sitting in front of you.

And when you wake up, we can take the time to make sure that you have your attention, that you’re fully aware of where you are, that your sight is good, you have no double vision whatsoever. So we can make sure that you’re fit and awake to perform the testing. And how does it work, then? The neurosurgeon will perform the electrical stimulation, while we do the tasks. And we start with motor function. So we will try to find a speech arrest, for instance, so that you can’t speak anymore. That’s sounds scary. But well, when he stops with the electrical stimulation, your speech regains. So you can easily talk again.

At some point, you can feel tired or exhausted, where you don’t want to go through. But we’re there, as a team. And I’m there to make sure that everything goes well. And that you can make it to the end, because we’re sure, as a team, that you can do this. And also, the stimulation can evoke emotional reactions. While we’re near the insula so– and near the resection of the tumour, possibly you can feel emotional, where you can cry or you can feel nauseous or whatever. Don’t be afraid. It will go away when we stop stimulating. When we pause the resection, those reactions also will go away.