Mediclinic Windhoek: Namibia's first musical brain surgery

Mediclinic Windhoek neurosurgeon performs Namibia’s first awake craniotomy with intraoperative musical performance.

The tumour’s effect on body function

The patient came to see neurosurgeon Dr Aamir Qureshi at Mediclinic Windhoek after an unsuccessful surgery in South Africa. She had a metastatic brain tumour in the motor area, which controls movement on the opposite side of the body. Although the tumour had been removed under general anaesthesia, she had woken up unable to move the right side of her body, Dr Qureshi explains.

After months of rehabilitation, she had slowly started to regain function but still had right-sided weakness and used a wheelchair for long distances. “She explained to me that her leg had got much worse to the point where she had no function of her right lower limb, although she was able to move her foot,” says Dr Qureshi. “She is right-handed and this hand was also starting to get weak.”

Meanwhile, the tumour had grown nearly two and a half times larger than before her first surgery. “This type of tumour is very aggressive, growing rapidly despite radiotherapy and chemotherapy,” Dr Qureshi explains. It therefore had to be removed carefully, while preserving as much function as possible.

Incorporating music into the awake craniotomy

Dr Qureshi suggested using neuromonitoring to check the patient’s brain function during surgery. “This allows us to send signals from the brain to the arm and foot while we operate,” he explains. But because of the tumour’s location, he couldn’t place the probes exactly where he needed.

He therefore recommended doing the surgery while the patient was fully awake so her movements could be assessed in real time. “Our main goal was to save her dominant right hand and keep it working as well as possible,” he says. “We also wanted to preserve the limited function she still had in her right leg.”

The patient was a recreational guitar player, so Dr Qureshi suggested she play during the operation. “The day prior to surgery, she practised the tune that she would play,” he says.

Because a “curtain” separated the patient and Dr Qureshi during surgery, they couldn’t see each other. “The only way I could assess her hand function was by sound,” he explains. Her music playing allowed him to check if her right hand could string notes correctly and keep the rhythm. If her hand began to weaken, she would lose the rhythm, and the nurse would step in to assess her function.

“She was awake the entire time – from numbing the scalp and positioning her, to making the incision, removing the bone, opening the dura (the outer membrane covering the brain and spinal cord), and operating on the brain itself,” he explains.

The procedure went well, the tumour was removed, and the patient retained full hand function. She then continued with radiotherapy and chemotherapy.

Surgery the first of its kind in Namibia

This awake craniotomy was the first of its kind in Namibia. A few months earlier, Dr Qureshi had performed the country’s first awake surgery to remove a clot in an elderly patient who could not be ventilated, as her reliance on oxygen meant she was unlikely to come off ventilation afterward. “Her surgery was not as intricate as the tumour patient, however, because I didn't have to go into the brain itself,” he says.

Before leading these pioneering surgeries, Dr Qureshi had assisted on similar procedures abroad, even operating on singers with tumours in the speech area while they sang.

The expertise of Mediclinic Windhoek’s staff was also crucial, as the surgery required careful planning and close collaboration across disciplines. “You need an entire expert team around you, from the anaesthetist to the nurse that does the neuro monitoring,” he explains. The patient also met the surgical team before admission to ensure she felt comfortable.

Neuroplasticity and balancing tumour removal with function

This procedure marks a new milestone in Mediclinic Windhoek’s neurological work and helps us to understand how the brain can adapt and how music can support its function. While humans cannot grow new neurons, the brain’s networks can adjust, Dr Qureshi explains.

“If neurons and fibre tracks of a network are stimulated in a certain way, then parts of that network can take over that role as a secondary function, which is where neuroplasticity comes in – in other words, if one part of the brain is damaged, other parts can sometimes adapt to perform its job.

“There are so many different networks that are being activated when you're listening to or playing music, from memory to movement control. The more networks you use, the better it is for your function going forward.

“What's important is that it’s not just taking the brain tumour out,” Dr Qureshi continues, “it's about getting the best functional result for the patient.” This is at the heart of an onco-functional approach, which focuses on treating the cancer while preserving the patient’s quality of life and abilities.