Staying Awake During Brain Surgery – On Purpose
Awake Craniotomy at Spectrum Health Gives Patients With Brain Tumors Hope
The thought of staying awake during surgery may be terrifying to most people but for one woman, it has allowed her to enjoy a better life.
In early July, Kim Bonnema was one of the first patients in West Michigan to undergo an awake craniotomy to remove two tumors in her brain. The surgery was performed at Spectrum Health Butterworth Hospital by Kost Elisevich, MD, PhD, co-chair, department of clinical neurosciences and chief, division of neurosurgery, Spectrum Health Medical Group.
Bonnema, 45, a Wyoming resident, has experienced seizures since she was 16 years old. An MRI of her brain revealed four benign tumors. In 1991, she underwent proton beam therapy in an unsuccessful attempt to treat the tumors. Despite taking antiepileptic medications, which left her feeling fatigued, Bonnema continued to experience seizures.
Fortunately, she was able to adapt her life around the disorder. The married mother of two teenagers has worked as an administrative assistant at Clark at Home since 2008.
"I was the healthiest-looking unhealthy person you could meet," recalled Bonnema.
The epileptic seizures, although controlled, continued. She remembers her two pregnancies as difficult because, forced to reduce her medications to protect the babies, she experienced several severe seizures, described as grand mal seizures.
Then, last spring, Bonnema started stumbling and losing motor function on her right side. Her neurologist, Timothy Thoits, MD, Spectrum Health Medical Group, ordered another MRI for Bonnema and learned that two new tumors had appeared and one of the previously identified tumors had tripled in size. Dr. Thoits referred Bonnema to Dr. Elisevich who suggested removing two of the tumors that were most affecting her life - one which caused her epilepsy and the other which was causing her difficulty with her right side motor function.
"The tumor that had enlarged dramatically was located between the motor and language areas of the frontal lobe of the brain. In such situations, it is important not only to remove the tumor, but to do it safely," said Dr. Elisevich. "For this, we needed to be able to interact with Kim during the surgery in order to assess her language and motor skills as the tumor itself was removed. An awake craniotomy involves arousing the patient from sedation during the surgery for this purpose."
Bonnema, once conscious, interacted with a speech pathologist and Elisevich in the operating room while electrical recording and stimulation of the brain surface was undertaken to map both language and motor areas.
"We asked Kim to move her right hand and wrist, to show a smile and close her eyes," recalled the neurosurgeon.
The second tumor, which caused Bonnema's epilepsy, was situated in another area of the brain, the temporal lobe, and required further electrical recording in order to identify the most excitable area in the vicinity of the tumor that was actually responsible for her epilepsy.
Bonnema didn’t hesitate to undergo the surgery.
"People asked if I was going to get a second opinion. But I had a great deal of confidence. I knew Dr. Elisevich would do a great job," said Bonnema.
Bonnema left Butterworth Hospital four days after surgery and spent less than two weeks of rehabilitation in Spectrum Health's Center for Acute Rehabilitation at Spectrum Health Blodgett Hospital before returning home.
Several months after the surgery, Bonnema remains seizure-free and returned to work during the summer, happy with her new life.
"Kim is a wonderful individual who has been through much already in her life. Her language and right-side motor function is no longer threatened and she will continue to improve as her brain readjusts. I suspect she will remain free of seizures arising from her temporal lobe now," said Dr. Elisevich. "We must remain vigilant about her other tumors to see that they don't come to interfere with her life in some fashion."
She will continue on her antiepileptic medications for a number of months before a decision is made to withdraw them entirely.
"I have a renewed appreciation for life. For the most part, my speech is fine. I just have to make myself consciously slow down at times. And my hair is growing back," explained Bonnema. "Life is good."
Spectrum Health is a not-for-profit health system in West Michigan offering a full continuum of care through the Spectrum Health Hospital Group, which is comprised of nine hospitals including Helen DeVos Children's Hospital, a state of the art children's hospital that opened in January 2011, and 183 service sites; the Spectrum Health Medical Group and West Michigan Heart, physician groups totaling more than 700 providers; and Priority Health, a health plan with 600,000 members. Spectrum Health is West Michigan's largest employer with 19,000 employees. The organization provided $204 million in community benefit during its 2012 fiscal year.