A five-year-old girl became the youngest patient in the world to have a brain tumour surgically removed by doctors at All India Institute Of Medical Science (AIIMS) in Delhi while she remained in a conscious state during the procedure. On 4th January, AIIMS revealed in a statement that the operation known as an “awake craniotomy” (conscious sedation technique) surgery for a left perisylvian intraaxial brain tumour was carried out.
The girl had a history of seizures and magnetic resonance imaging (MRI) of her brain detected a tumour next to the speech and language centre on the left side of the brain, according to the statement. Her local anaesthetic was administered by neuro anaesthetists during the three-hour procedure. She was aware during the entire procedure which involved a team of neurosurgeons effectively eliminating the cancer.
It further read, “Technological adjuncts viz preoperative functional MRI brain, intraoperative ultrasonography, neuronavigation were used to localise tumour precisely during resection while mapping of functional areas was being carried out under awake conditions. Ice-cold saline was used for the brain surface to prevent any seizures during the procedure. The child is doing well and will be sent home on Monday.”
The decision to proceed with the surgery was made after a lengthy discussion involving the youngster, her family and the team of doctors. It stated that they received thorough counselling on the processes involved in the course of action. Before surgery, she completed certain exercises for linguistic and sensorimotor tests, viewed familiar objects and animals and had these activities replicated during the surgical procedure. According to the statement, the first-standard student recognised the photo of Prime Minister Narendra Modi during the procedure with ease.
“Awake surgeries for brain tumours are done for maximising tumour removals and minimising neurological deficits usually. During awake craniotomy, patients should feel a minimum level of pain while being completely able to cooperate in neurological tests,” the statement mentioned.
Professor of Neurosurgery Dr Deepak Gupta remarked, “Although this method is called an awake craniotomy, this method requires even more collaboration in perfect harmony of the surgical and anaesthesia teams than other operations under general anaesthesia.” He executed the operation assisted by Dr Gyanendra Pal Singh and Dr Mihir Pandia of the neuro anaesthesia team. He added, “Akshita happens to be the youngest child in the world to undergo successful brain tumour surgery under awake conditions at this age at AIIMS, Delhi.”
Physicians observed that kids as young as eight years old have undergone comparable procedures in other countries. Rakesh Yadav, Akshita Yadav’s father and a software engineer expressed appreciation for AIIMS’s assistance. He described the difficulties he and his family had endured since his daughter’s brain tumour was discovered in 2020 as a result of her repeated convulsions prompting medical attention. “Since her tumour was in the speech area, we were advised to go for an awake craniotomy as the entire tumour cannot be removed in normal surgery. We decided to take the risk and prepared our daughter. The doctors at AIIMS supported us and ensured good results.”
He unveiled, “She fell down while walking with me. She was taken to a local doctor but he didn’t identify the reason and sent her back after prescribing some medicines. This episode was repeated several times. Then we took her to a hospital and got to know about the brain tumour,” and added that she sometimes had 3-4 episodes of seizures in a week.
It was surprising, according to Prof. Mihir Prakash Pandia of the neuro-anesthesia department to have such cooperation from a tiny child. He reported that her brain tumour was 21.7*21.7*24.4 mm in size. “Nearly 16-18 injections were given to the patient to block the nerves,” he conveyed and noted that the surgery took three hours total, involving the time needed for the child to get local anaesthetic from neuro anaesthetists. The surgical team comprised seven physicians, paramedics and technicians.
“I will go to school in two weeks. Doctor uncle has advised me to take rest till then,” Akshita Yadav stated in an interview. She informed that she experienced no fear during the surgical procedure and expressed her excitement for her 22nd March birthday celebration.
A very sophisticated form of brain surgery known as an awake craniotomy allows the patient to remain conscious and responsive during the whole procedure. With the help of this innovative technique, surgeons can effectively explore the intricate workings of the brain, safeguarding vital processes like speech and movement in real time. The ability to carefully monitor essential brain functions while conscious lowers the possibility of complications following surgery.
This surgical technique is extremely important for treating tumours or epileptic areas close to important brain structures. Awake craniotomy is useful in identifying and maintaining particular brain functions associated with movement, language, and sensory perception. This methodical approach greatly reduces the likelihood of post-surgical deficits and guarantees optimal preservation of normal brain tissue.
AIIMS highlighted the incredible application of state-of-the-art technology used in the procedure, including neuronavigation, intraoperative ultrasonography and functional MRI. These cutting-edge instruments were essential for accurately identifying the tumour and imaging every functioning region of the brain.
This extraordinary procedure is a mirror image of the successful awake craniotomy that AIIMS conducted on Yukti Agarwal three years ago during a similar brain tumour surgery. She chanted Hanuman Chalisa during the operation and is reportedly doing well at present.
