HIS head throbbed and his speech started to slur.

Was it a stroke? That was the first thing airline executive Joel Goh, 32, thought.

He was waiting for the bus to take him to the airport after holidaying in Vietnam, when it happened.

He was there with friends and wife, Madam Cherry Chan, a 29-year-old teacher, in September last year. Because of his medical history of high blood pressure, Mr Goh initially thought that he had a mild stroke – one that can last from one to 24 hours.

But magnetic resource imaging (MRI) scans taken at Singapore General Hospital (SGH) when he returned showed that he had a tumour in the left front portion of his brain.

The tumour was about the size of a ping-pong ball.

Mr Goh was given three options:

To do nothing, which is often the normal medical procedure;

To undergo a biopsy;

To go for surgery – or what doctors call an awake craniotomy.

An awake craniotomy is like a brain surgery with one critical difference: The patient would be wide awake once the surgeons have access to the brain. The surgery involved the use of iMRI (intra-operative MRI) technology, which was introduced in local hospitals last April.

To date, only about 12 patients in Singapore have undergone operations combining an awake craniotomy with iMRI scans.

His doctor, Associate Professor Ivan Ng, 42, senior consultant and head of the neurosurgery department at the National Neuroscience Institute and SGH, advised him against the first two options.

Take it all out

Said Mr Goh: "What the doctor recommended was to take it (the tumour) all out through an awake craniotomy. The doctor thought I would be the best instrument for them to judge how much of the tumour they can remove."

After a one-month delay because of Mr Goh’s flu, the entire tumour was removed successfully in a seven-hour operation.

Mr Goh was administered anaesthesia intravenously when surgeons had to drill through his skull to expose the brain.

Once this was done, the supply of anaesthesia was cut, with Mr Goh wide awake.

Prof Ng explained: "The patient was totally awake. He was not semi-conscious because if he were in that state, he might have been thrashing about. That would have been dangerous. However, he would not be able to feel any pain during the surgery as there are no pain receptors in our brain."

Mr Goh recounted his experience: "Before the operation, I feared dying on the table because I have a wife and child. "I also did not want to miss out watching my son, Josh, grow up. So that was a real fear."

Josh turns 1 this month.

During the surgery, Mr Goh had to respond to surgeons’ instructions, such as raising his right arm or leg when told.

This was to ensure that the surgery did not affect the part of the brain which controlled his movements.

Even though Mr Goh knew that the technology used in the operation was relatively new, he was not apprehensive.

"Prof Ng told me it was the best technology around, and the equipment was state-of-the-art.

"He also assured me that it was a procedure that would work the best in my case. He also went on to say that if there was no such technology, you shouldn’t allow people to touch your brain."

For Mr Goh, the risk of paralysis with the use of the new technology was 10 to 15 per cent, compared to past operations where the risk ranged from 50 to 70 per cent.

But complications cropped up after the operation. Mr Goh did not regain control over his body parts immediately as his body had to rewire itself to the brain. He could not do what he used to do – like writing, holding cutlery, talking or even maintaining his balance – without difficulty.

"After the operation, I was so afraid that I might not fully recover because I had weakness on the right side of my body."

He also had difficulty speaking and became withdrawn. But 11/2 months later, when the swelling in his brain subsided, Mr Goh recovered his motor skills fully.

– Audrey Tan Ruiping, newsroom intern

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