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Huntington Hospital Doc Performs Awake Craniotomy

Islip native has brain tumor successfully removed while being awake during surgery.

When it comes to epic brain surgeries, there is prime-time television and then there is Huntington Hospital.

Twenty-three-year-old Boris Arriaza, of Islip, successfully underwent a complicated brain surgery on July 12 in which he was conscious throughout part of the procedure. The procedure known as awake craniotomy, was the first of its kind to ever be performed at the North Shore-LIJ Huntington Hospital.

Dr. Ramin Rak, the performing neurosurgeon, said he did such a surgery only once before.

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"This is a very rare type of operation," Dr. Rak said. "It was the first time at Huntington Hospital and only few hospitals around the country perform this kind of surgery."

Arriaza was admitted to Huntington Hospital after he had a seizure in his car while he was stopped at a red light on July 5. Upon examination, Arriaza was diagnosed with a tumor in the speech cortex, near the temporal lobe of the brain. One week later, on July 12, he underwent this unusual brain surgery where Arriaza was kept awake as he needed to respond to various questions during the tumor removal to ensure that no damage would be done to the part of the brain that controls speech and language. And just four days after the surgery, Arriaza walked out of the hospital, ready to reunite with his family.

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"I am very grateful to Dr. Rak and the hospital," Arriaza said. "I want to be alive for my children."

Dr. Rak explained that surgeries like this aren't common nor was the location of Arriaza's tumor. "Because it was right on his speech area, there was no way to map and understand how we are going to control the reception of the brain without the patient being awake," Dr. Rak said. "So we talked to him and showed him pictures during surgery and make sure we don't damage certain areas which affect his speech."

Dr. Rak added that as long as Arriaza was able to answer the questions, then he would know that he is not near any vital tissue. But this also meant Arriaza needed to be awake during the procedure without any general anesthesia or breathing tube.

"I was nervous when Dr. Rak first told me the diagnosis, but happy to hear that the tumor was operable," Arriaza said. "Dr. Rak told me that I would be conscious for the surgery, and that it might be uncomfortable and possibly a little painful. During the surgery, they showed me pictures and asked me to name the objects [like] a horse [or] a table."

Dr. Rak further explained how there could have been many complications in the surgery.

"If anything goes wrong during the surgery, we don't have much control and it can be devastating," he said. "When the patient is under general anesthesia, you can control many parameters but when they are awake, complications like serious bleeding makes things much more difficult. In this case, everything went perfect."

Not only was the surgery a success, but stuttering and slurring that Arriaza dealt with for many years before the tumor was discovered subsided after the procedure.

"Before the surgery, I sometimes stuttered and sometimes slurred my speech," Arriaza said. "If I was speaking to someone, I would forget a word or lose track of what I was saying. After the surgery, my speech was much better."

Arriaza, who is a native of Guatemala, had a translator present during the surgery due to his limited English proficiency. Advanced technology such as functional magnetic resonance imaging (fMRI) was also an asset to the procedure, providing images to show which parts of the brain were active during specific speech and language functions.

Dr. Rak said he was very pleased with the success of the procedure.

"I feel very good," he said. "I am very happy I was able to help this young gentleman and even make him even better after surgery as far as the speech. His outcome is going to be much better now that I was able to remove that entire tumor."

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