Call for more 'awake' brain surgery
Health chiefs were today urged to allow doctors to carry out more awake surgery to treat brain tumours.
Despite it taking longer and costing more, the Irish Cancer Society revealed it has a higher success rate and any damage caused to delicate tissues can be corrected.
The latest figures from the National Cancer Registry show there were 316 new cases of primary brain tumour diagnosed in 2002.
On average 213 people die from brain tumours every year.
Dr Michael Farrell, neuropathologist, Beaumont Hospital, said more staff had to be trained in the awake surgery technique and more funding was needed.
“Awake surgery should be performed more widely especially in the resection of low grade tumours but at present we do not have the trained staff and because the surgery takes 25-50% longer, we do not have enough theatre time,” Dr Farrell said.
The call for more awake surgery was made at a major conference on brain tumours in Dublin.
The Irish Cancer Society also want to see more neurosurgeons in hospitals. At present there are only six consultants in Dublin and three in Cork.
Delegates learnt how awake surgery, which is common place in the US, has only recently been practised in Ireland on a limited basis.
Patients are sedated at the beginning of the operation and then woken up. Neurological status of the patients can then be monitored as the surgeon removes the brain tumour.
If the surgeon resects too much the patient might suffer a disability with speech changing or the movement in arms and legs being affected, but this can then be corrected.
However for awake surgery to be conducted more widely, the surgeon needs to be assisted by trained anaesthetic personnel and ideally a psychologist or a neurologist who can assess any complication which might occur during the surgery.
Awake surgery also takes 25% to 50% longer than usual surgery where the patient is fully anaesthetised and is therefore more costly in terms of making theatre space and appropriate and trained personnel available.
Dr Farrell said he hoped this issue would be addressed when the HSE and Price Waterhouse reports on the development of neurosurgical services here.
“At present we have about half the number of neurosurgeons required and our waiting times are significantly longer than those in the US,” the doctor said.
“When an urgent case presents, the other less urgent elective cases are also delayed.
“We also have to account for the fact that in addition to treating patients with brain tumours, neurosurgeons also treat patients with brain haemorrhages, brain defects and disease, spinal tumours, head injuries and epilepsy.”
Mr Donnacha O’Brien, consultant neurosurgeon at Beaumont Hospital, said more had to be done to continue to improve survival times and quality of life for patients with brain tumours.
“It is now appropiate to look at combining surgery, radiotherapy and chemotherapy to make a more aggressive treatment regime and conducting MRI scans during brain surgery which can help with maximisation of the resection,” he said.
Delegates also heard how necessary it is to perform MRI scans during brain surgery to help with maximisation of the resection of the brain tumour. MRI scanning during surgery can detect if the surgeon has removed all of the visible tumour. However there is no intra-operative MRI scanner in either Dublin or Cork.
