Chennai, Sept 11: She was playing her favourite game on her uncle’s mobile phone when a team of surgeons were removing a tumour from the most sensitive part of her brain at a hospital in Chennai recently.
By staying awake, talking and moving her limbs, 10-year-old Nandini gave her doctors the confidence that they were on the right track.
The Class V student, who is also a Bharatanatyam dancer, was brought to SIMS Hospital with complaints of sudden onset of fits. Brain scan revealed that she had a tumour in an important area of brain which controls the movement of the left half of the body, including face, hand and leg.
SIMS Hospital neurosurgeon Dr Roopesh Kumar told her parents that if the tumour grew further, it could cause paralysis or could be fatal.
In a conventional procedure, called craniotomy, a disc of bone is removed from the skull using special tools to give surgeons access to the brain when the patient is unconscious.
"I did not want to go in for the conventional method of removing the tumour. It was in the sensitive part of the brain and if we accidentally touched a wrong nerve, it could cause complete paralysis of left half of her body," he said.
The doctors decided to do the same procedure by keeping the patient awake and alert. "That way, I will know exactly which areas of your brain control those functions and avoid them," Dr Kumar said.
The awake surgery is done in nearly 2% of brain tumour patients who are adults, but is rare in children, said SIMS Institute of Neurosciences director Dr Suresh Bapu. The patients feel no pain during the surgery since the neurons in the brain don't have pain receptors.
While her parents were initially hesitant, the surgeons took the help of the patient's uncle in Puducherry, who is a doctor, to convince them.
"I was in the theatre when the removed the tumour. Nandini was playing Candy Crush on my cellphone. She moved her hands and legs when we asked her to do so. The surgeon had to make sure that the point he is operating on does not affect her mobility. She was brave," said her uncle.
The family told doctors that they were worried about the post-surgical stress but doctors said studies from medical literature showed that such surgeries were safe in children.
"It's rare in children, but we did have enough evidence," he said.
In June 2017, World Neurosurgery, a medical journal, published the psychiatric and psychological impact of the awake brain tumour surgeries in children after following up on case sheets of seven children -- aged between 8 and 16 -- post surgery.
The results showed that none of the children had initial psychiatric problems. While parents experienced anxiety, no child showed signs of post-traumatic stress disorder.
Such studies gave confidence to the entire team, said neuro anesthetist Dr Sudhakar Subramaniam, who stood by the patient side during the three and a half hour surgery.
At the end of the procedure, she was moving her hands and legs. She was discharged from hospital last Friday, two days after the surgery. Nandini told the doctors that she would resume Bharatanatyam practice in a few days.
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