KUBANG KERIAN, 4 December 2017 – World-renowned neurosurgeon, Professor Saleem Abdulrauf has been highlighted in a number of medical journals on his success in ‘Awake Brain Aneurysm Surgery’. It was regarded as a ‘world's first’, where clipping is done on the unruptured brain aneurysm while the patient is awake.

Advantages of awake brain surgery would be in lowering the risks of brain ischemia with neurological deficits (stroke) and ventilator associated morbidities. The technique has been regarded as a new frontier in brain surgery.

Recently, physicians from Universiti Sains Malaysia (USM) School of Medical Sciences, at the Health Campus in Kelantan, also performed a similar procedure. 

The surgery, being the first that was performed in Asia and in the country, was done by the local USM surgery team headed by Professor Dr. Zamzuri Idris (neurosurgeon) and Dr. Wan Nazaruddin Wan Hassan (neuroanaesthetist). Prior to this, they have performed many awake brain surgery for brain tumours, but this was their first ever awake surgery on brain aneurysm.

Currently in the world, only one or two centres for Neurosurgery are capable of doing this type of surgery. The USM team at the centre therefore can be considered to be among the first few to have done this new frontier brain surgery and to achieve success.

Technically, this type of surgery (awake vascular brain surgery) is commonly seen as a challenging procedure, but with the available expertise and facilities, the USM team performed the surgery as a good alternative to complete-sleep brain surgery (i.e. under general anaesthesia).

Under complete-sleep brain surgery, no immediate neurological assessment on the patient can be made at time of surgery. Thus, the success of the surgery would provide another example of how awake brain surgery in neurosurgery would be of benefit to patients concerned.

Figure 1: A and B – MRI and CT Angiography brain show presence of saccular aneurysm (red circle); C – the intraoperative view of awake brain surgery using microscope, Prof. Dr. Zamzuri Idris is the one sitting on a chair using the microscope; D – microscopic view of clipped brain aneurysm (asterisk) and E – the awake and no endotracheal tube patient while performing the vascular brain surgery.

Text: Mazlan Hanafi Basharudin