A woman in Panay remains conscious to assist her own brain surgery

Elyza Dimaapi

Beneath the lights of a silent operating room, a woman lay awake—not dreaming, but living through a historic moment and guiding her surgery as Panay witnessed its first conscious encounter between blade and brain.

Heroic scenes of awake craniotomy made it out of sci-fi medical dramas years ago. But in a historic feat, the Panay region succeeded in adapting the operative method, which is primarily offered by huge hospitals in Metro Manila.

Last July 17, the Western Visayas Medical Center (WVMC) in Iloilo City bet against the odds and successfully performed the first-ever awake craniotomy in Panay Island’s history, a groundbreaking achievement in regional neurosurgical care. 

Awake brain surgery, or awake craniotomy, is a brain procedure performed while a patient is awake and alert—guiding the surgeons throughout the surgery.

According to the Mayo Clinic, this medical procedure is an approach for complex neurological diseases, including some brain tumors or epileptic seizures.

A 43-year-old woman with an intracranial tumor underwent a six-hour operation. The surgical team succeeded in removing a tumor located at the left temporal lobe of her brain.

Temporal lobe is crucial in processing auditory information, memory formation, and language formation. Therefore, it requires precision in resecting the tumor to avoid disruption of these functions.

The surgery was led by Dr. Derek Ben Jabines, a neurosurgeon and spine specialist, alongside a multidisciplinary team including Dr. James Mercado from Davao Doctors Hospital, Dr. Ceres Lucot-Laud, a neuroanesthesiologist, and Dr. Paul Christian Sobrevega, a neuropsychiatrist.

In a statement, Dr. Joseph Dean Nicolo, chief of WVMC, underscored that awake craniotomy keeps the patient awake for the real-time monitoring of brain functions—the main goal for the safe removal of their patient’s left temporal lobe tumor.

The said process is called awake brain mapping. According to the University of California San Francisco (UCSF) Brain Tumor Center, it requires patients to do various tasks while the surgeons are stimulating specific parts of the brain.

Patients assist the process by answering questions to help identify which parts of the brain are critical for functions like language or body movement.

It is possible within the absence of pain receptors in the brain. Local anesthetics were only administered to numb the scalp while a nerve or scalp block injection was given to block pain.

Yet, amidst its promising application on tumors that are often considered inoperable primarily due to size and/or location, it is not applicable to every patient. 

Based on John Hopkins Medicine, patients with any type of sleep apnea and who are obese are not qualified for awake craniotomy. 

They also highlighted that a patient must be emotionally ready for the procedure.

Rooted to this is the success of Panay’s first awake brain surgery. Lucot-Laud pointed out how vital the patient selection is for the success of the procedure. 

“The patient should be emotionally prepared. I have to meet the patient siguro three to four days before the surgery. I have to establish a good rapport. The folks and the patient should understand the risk of the said procedure and they naman,” Lucot-Laud emphasized.

Following their success, WVMC has committed to including awake craniotomy in the services at the hospital’s Brain and Spine Center to make the procedure accessible for the people of Western Visayas.

However, details on the surgical cost were not yet made clear, nor was it clear if it is eligible for the benefits of the Philippine Health Insurance Corporation (PhilHealth).

For now, one woman’s courage and the brilliance of a determined medical team have redefined what’s possible in Panay.