John James lay on the operating table, a hole in his head and a nurse showing him flashcards.
The Canberra man had the unique experience of being awake while neurosurgeons drained the blood out of a potentially fatal aneurysm that had formed in a vein inside his brain.
As surgeons probed the 1.5cm hole they had cut through his skull, Mr James read words and numbers on the flashcards aloud to let them know the risky operation was not damaging his vision or thinking.
The retired bus driver today said it was a strange feeling listing to doctors speaking during the operation.
“The nurses looking after me, they were talking to me,” he said.
“I could only see bits because I couldn’t move my head at all.”
“I wasn’t worried whatsoever … I was quite confident all the way through.”
The medical team believe his operation was a world first, based on the combination of the high technology equipment used, the tiny “keyhole” incision they made and the fact Mr James was conscious throughout the procedure.
“As far as I’m aware reading the literature, this kind of thing done as a package has never been done before,” Canberra Hospital neurosurgeon Dr Vini Khurana said.
“So we were pleased, the result was obviously very good.”
Mr James, who turned 78 two weeks ago, went to the doctor complaining of blackouts and problems with his vision.
Scans found an abnormal tangle of veins and arteries in his brain that had formed the aneurysm, similar to a blister.
Surgery was urgent because the particular type of venous aneurysm was “very prone to haemorrhage”, Dr Khurana said, which is often fatal.
But the location of the aneurysm just behind Mr James’ right eye meant it would be risky, and removing it could have cut off the blood flow to his eye, sending him blind.
“That’s why we wanted Mr James to be awake during that portion of the procedure,” Dr Khurana said.
“We wanted to be sure that in disconnecting this high-flow structure we didn’t in any way impair his vision.
“An error in that circumstance could be fatal.”
The surgeons rehearsed the procedure using virtual reality software that created a 3D image of Mr James’ brain.
Using tools just 1.5 mm thick, they cut through the leathery covering of the brain, teased the aneurysm free, and used a titanium clip to drain the blood out.
During the April 26 procedure, Dr Khurana could see a three-dimensional MRI scan of Mr James’ brain projected onto the right hand side of his eyepiece.
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