State-of-the-art brain surgery technology comes to AKUH

Over 250 operations performed resulting in quicker recovery time for patients

KARACHI: Brain surgeries are among the most delicate and critical procedures to take place at a hospital, as many areas of the brain are considered too sensitive to operate on, as they control the key functions of cognition and memory.
Reaching such areas of the brain is inherently risky, as vital parts of the brain are likely to suffer trauma when a surgeon navigates toward the area affected by a brain tumour.



The complex procedures done to treat the most complicated brain and central nervous system-related conditions are now possible in Karachi due to the availability of a state-of-the-art neurorobotics exoscope and neuronavigation system that was previously only available in the United States and Canada.

The newly-imported machine provides advanced imaging facilities that enables surgeons to see deeper into the brain. The detailed, 3D images of the fibres inside the brain distinguish between safe and precarious areas that help a surgeon decide the safest approach to reach the area affected by the brain tumor before starting the surgery.



The introduction of this rare technology was a result of the collaboration between Pakistani neurosurgeons and experts based at a hospital in Wisconsin in the US. The process of bringing and introducing the system worth over $1 million to Pakistan began in 2014 when the decision was made to establish a centre of excellence in neurosciences in Karachi. After detailed discussions with the manufacturer of the system, Pakistan-based neurosurgeons identified training as a key area where assistance was needed.
"Minimally invasive neurosurgery is all about precision. While the exoscope's advanced imaging gives surgeons vital, additional information in real-time, you also need an experienced team that can make the most of this technology," said Aga Khan University Hospital (AKUH) Department of Surgery Chairperson Professor Ather Enam.



Professor Enam later contacted Dr Amin Kassam, chairperson of the department of neurological surgery at Aurora St Luke's Medical Centre in Wisconsin the same year to arrange personal training for using the system. During this time, anaesthesia specialists, neurosurgeons and biomedical engineering experts from Pakistan worked closely with their American counterparts in Milwaukee - the largest city in state of Wisconsin - to gain skills that they would bring back to the country.
Once the training was complete, the team visited the manufacturer's factory to gain a deeper understanding of the technology and to discuss practical aspects of bringing the system to Pakistan. Following a generous donation from Bashir Dawood, an industrialist and philanthropist who helped finalise plans to bring the equipment to Pakistan, the facility became operational at the AKUH in April, 2016.



Since the exoscope's installation at AKUH over 250 operations have been performed with enhanced precision of treatment resulting in a quicker recovery time for patients. The introduction of the equipment has facilitated groundbreaking awake craniotomies - a procedure that was previously unavailable in Pakistan - where the patient is kept awake during surgery enabling better treatment for brain tumors and other conditions.
Professor Enam said not all neurosurgery patients are candidates for awake craniotomies but in cases where an awake craniotomy can be done with electro-cortical mapping (plotting areas of electrical activity in the brain), the risks of neurological complications are significantly reduced.



"This partnership demonstrates how brain gain can take place when specialists from different teams work together to maximise the potential of revolutionary technology," Professor Enam added.