THE STAR, TUESDAY 4 JULY 2023
Understanding neurosurgery
WHEN faced with the possibility of brain
surgery, the first emotion we would likely
experience is instinctual unease. This is a
natural reaction as our personalities,
thoughts and other aspects that define us
are inextricably linked to brain function.
The thought of having our identities
being permanently altered can be
unsettling.
Fortunately, it is a big misconception
that neurosurgical intervention causes
sudden personality shifts. The reality is
that these drastic changes are more often
associated with brain tumours. If left
untreated, it carries more severe risks
and consequences compared to the
relatively low risk of surgery.
Moreover, the field of neurosurgery
in Malaysia has made significant
advancements in both surgical technique
and medical technology, further reducing
risk associated with neurosurgical
procedures, while enabling more precise
and effective treatment.
It is important for Malaysians to
develop better understanding of brain
tumours and available treatments to help
them make more informed decisions and
protect the health of both themselves and
their loved ones.
Who is at risk?
Brain tumours can affect anyone
regardless of age or lifestyle and its effects
can range from being relatively benign to
potentially life-threatening depending on
its size, location and development. The
cause for primary tumour growths that
originate from the brain is still unknown.
It is generally advisable that individuals
undergo an MRI scan if they experience
clinical symptoms as described in this
article, although this can vary depending
on the patient’s condition and situation.
Patients with cancer are also more likely
to develop secondary brain tumours
(caused by the spread of cancer cells from
other body organs). An oncologist will
recommend these patients undergo serial
MRI screenings once every three to six
months.
Common symptoms
One of the tell-tale signs of a brain
tumour is persistent and severe
headaches, especially if the headaches get
Dr Toh Charng Jeng.
progressively worse over time. A sudden
change in headache intensity and pattern
could also be indicative of a brain tumour
but not all headaches are indicative of a
tumour.
Other symptoms of brain tumours
include an unsteady gait, blurred vision
and vomiting. Unfortunately, these
symptoms can sometimes be overlooked
BRAIN HEALTH
and mistakenly attributed to other
comorbidities, causing brain tumours to
remain undiagnosed for many years.
Interventional pain specialist,
neurosurgery and spine surgery expert at
Sunway Medical Centre, Sunway City, Dr
Toh Charng Jeng emphasises the subtle
nature of brain tumours and the potential
difficulties in identifying them.
“It is common for older patients, for
example, to miss signs of brain tumours.
They generally have their attention
slowed down and maybe talk less than
before. Some may think this is just a part
of dementia.”
“Patients must always consult a
neurologist before jumping to conclusions.
You shouldn’t assume psychiatric illness
until you rule out red-flag conditions like
tumours, especially if their symptoms do
not present themselves as typical
dementia signs, for example, as it would
need to be investigated further.”
Given the difficulty of noticing personal
behavioural changes in oneself, we must
rely on our loved ones to notice unusual
or persistent changes in our attitudes and
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2 Brain Health
Keeping the mind active
ACCORDING to the World Health
Organization (WHO), approximately 70%
of the global burden of neurological and
neurodevelopmental conditions affects
low- and middle-income countries.
Neurological conditions are the leading
cause of disability and the second leading
cause of death in the world with nine
million deaths annually. Stroke, migraine,
dementia, meningitis and epilepsy are the
top five contributors to neurological
disabilities globally. With an increasing
ageing population, Alzheimer’s and
Parkinson’s disease are also becoming
more significant.
According to medical director and
consultant neurosurgeon Prof Dr
Badrisyah Idris at MSU Medical Centre,
“The brain is a unique organ with three
important functions that affect our lives
which are, sensory interpretation and
movement control; cognitive, mental and
emotional integrity; and behaviour and
social execution.”
Brain health is becoming an important
concept in healthy living which
encompasses the ability of the brain to
rewire in life in response to changes in
experience and environment. A healthy
brain is capable of slowing down cognitive
decline and combating any injury or
diseases of the brain. There are several
things that we can make a habit to
maintain our brain health.
Regular physical activity can benefit the
brain by optimising the brain’s blood flow
and reducing the loss of brain cells during
ageing. Those who exercise regularly can
Breakthoughs in brain surgery
> FROM PAGE 1
recommend medical consultations.
Advancement in technology
Thanks to many advancements in the
field of neurosurgery over the decades,
surgical procedures on brains have
become exceedingly safe. The integration
of image guidance, imaging dyes and
microscope enhancements are great
examples of assistive technology and play
a key role in enabling surgeons to
perform surgeries with improved
precision and consistency.
Dr Toh adds, “The advancement of
technology is to assist neurosurgeons in
treatment. Thanks to assistive machinery,
a surgeon’s work has become more
consistent. For example, technology has
enabled neurosurgeons to take advantage
of intraoperative neurophysiology
monitoring, which allows surgeons to
monitor nerves while performing
surgery. This helps with avoiding injury
to the nerve as the machine can warn us
earlier.”
Other techniques and technology
include the ultrasonic aspirator that
breaks brain tumours into smaller pieces
to be extracted even with small
craniotomy opening (keyhole
neurosurgery) and the awake craniotomy
that keeps the patient awake during
surgery to give real-time essential
feedback which further reduce the risk
enjoy healthy cognitive abilities and have a
lower risk of developing dementia.
Exercise helps to lower blood pressure
reducing cardiovascular risks of getting a
stroke. Some studies have found that
regular exercise increases the level of a
protein that promotes the growth and
maintenance of brain cells. Having an
active lifestyle such as taking the stairs,
engaging in sports or hobbies or having
purposeful exercise such as brisk walking
or aerobic training can have a positive
impact on brain health.
Quality sleep is important for brain
healing and the restoration of mental
function. Sleep makes our thinking
processes sharp and focused with better
decision-making. Seven to eight hours of
sleep gives the brain adequate time to clear
abnormal proteins that accelerate
dementia. Several lifestyle measures can
be adopted to ensure no alteration in sleep
patterns such as increasing time in the
sunlight, consistent sleep routines and
being aware of the effects of medications.
The brain is only 2% of the body weight
yet it consumes 20% of energy
requirements. Without the right energy
and nutrients, the brain will start losing its
function. Food rich with antioxidants
(compounds that have a protective effect
on the brain), fibre, unsaturated fats
(including omega-3 fatty acids), B vitamins
and an adequate amount of complex
carbohydrates is important to maintain a
healthy brain. A diet rich in processed
foods, salt and refined sugars can increase
inflammation and free radicals in our body
of surgery.
There is also the gamma knife (GK), a
very powerful, precise and least
collateral radiosurgery machine used
today and developed by neurosurgeon
Lars Leksell in 1967 specifically for
cranial pathology. Advancements in
cancer treatment have improved survival
rates in cancer patients with increased
incidences of brain metastasis; but with
the GK, cancer tumours can be controlled
or reduced dramatically, translating to
more improved survivals for patients
with stage four brain metastasis. It is also
useful when surgical risk is too high for a
small tumour situated deep in the brain.
Given the individualistic nature of the
human brain as well as tumour
development, neurosurgical
interventions are typically tailor-made
for each patient. Patients can rest easy as
doctors guide them through all available
treatment options and recommended
procedures, empowering them to make a
decision that is most suited for their
condition.
Overall, the notion that brain surgery
is dangerous is largely misconstrued as
rapid improvement in neurosurgical
techniques and technology alongside the
dedication of neurosurgeons, surgery risk
has been drastically reduced, enabling
former brain tumour patients to continue
living long and fulfilling lives.
n For more information, call 03-7491
9191 or WhatsApp 012-635 0113.
Prof Dr Badrisyah Idris.
that can negatively impact brain health.
Cognitive stimulation by learning new
skills or knowledge helps the brain to
become constantly healthy with the
formation of new circuits between brain
cells. Challenging the brain increases its
cognitive reserve by creating an adequate
backup system. With more reserves, the
brain can become more resistant to
changes that are associated with
neurodegenerative diseases. Education
and learning enhance the cognitive
reserve which makes the brain less
susceptible to the effects of age and brain-
related changes.
Depression and anxiety can be
detrimental to brain health with their
Food for thought
MAINTAINING a healthy mind is just as
important as maintaining a healthy body.
As the central organ of the body, the brain
requires plenty of energy and nutrients to
keep the body properly functioning. Here
are some foods that help improve brain
health:
Fatty fish
Fatty fish is rich in omega-3 fatty acids,
a type of unsaturated fat that can
improve brain health through building
brain and nerve cells, which are
important for memories and learning. It
also helps lower the risk of heart disease
and arthritis. Fish that are rich in omega-
3 fatty acids include salmon, cod, sardines
and mackerel.
Vegetables
Leafy vegetables are good for
maintaining a healthy body weight. They
also help with boosting cognitive
functions. Vegetables such as kale,
spinach and broccoli are rich in nutrients
like vitamin K, lutein, folate and beta
carotene. Vitamin K and beta carotene in
particular have been linked to help
THE STAR, TUESDAY 4 JULY 2023
“The brain is a unique
organ with three
important functions
that affect our lives
which are, sensory
interpretation and
movement control;
cognitive, mental and
emotional integrity;
and behaviour and
social execution.”
Prof Dr Badrisyah Idris
effects on mood and emotion. These
conditions lead to slow thinking, memory
and concentration difficulties. Social
connectivity helps to get rid of depression
and anxiety. Socialising helps the brain
expand its cognitive reserve. Engaging in
conversation trains the brain to increase
attention and concentration, and helps
social judgement. Therefore, it is
important to stay connected with friends
and families to maintain healthy brain
functions.
prevent memory loss.
Eggs
Eggs has been associated with improved
cognitive performance in adults, as
published in a 2019 study in The American
Journal of Clinical Nutrition. This is
because eggs, specifically the yolk, are rich
in choline which helps the brain regulate
memory and mood. Furthermore, eggs are
also rich in vitamin B which can help with
slowing down mental decline and
regulating sugar levels in the brain.
Blueberries
Blueberries are high in nutrients and
low in calories. In addition, blueberries
contain the highest amount of
antioxidants which help protect against
free radicals and inflammation.
Antioxidants also prevent oxidative stress
which can contribute to
neurodegenerative diseases.
While we always stress over
maintaining the health of our bodies, it is
also important to not neglect the health of
our brains. A healthy mind leads to a
healthy well-being.