Kloof surgeon makes world headlines

A KLOOF neurosurgeon has made headlines, both nationally and internationally with his recent awake craniotomy during which the patient was asked to play his guitar.

Dr Basil Enicker and his team in the Department of Neurosurgery (University of KwaZulu-Natal and Inkosi Albert Luthuli Central Hospital) led a team that performed surgery on a jazz musician, Musa Manzini, while he was awake, to remove a brain tumour.

The humble father and husband, who moved to Kloof in 2016, said it has truly been an exciting experience for his colleagues to have their work receive such positive feedback both locally and internationally.

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“We are always excited when we achieve a successful outcome, after treating patients. In the Department of Neurosurgery we believe in teamwork, as this approach leads to effective management of patients in our unit. The patients’ needs and aspirations are central when we execute treatment plans. For us this affirms the quality of care and cutting edge surgical treatment rendered at our institution,” said Enicker.

He has two sisters and both his parents were teachers. He said growing up from humble beginnings in Umlazi township contributed to the person that he is today. Enicker said he was a quiet and shy boy growing up.

“I have good memories of growing up in the township, the sense of community and the many friendships fostered from playing soccer in the streets. Some of these friendships last till this day,” he said.

He attended schools in Umlazi until Standard 6 (Grade 8). “I then attended St Francis College, Mariannhill from Standard 7 (Grade 9) until matric.”

What made him pursue a career in neurosurgery?

When he was a medical student at the Nelson R Mandela School of Medicine (University of KwaZulu-Natal), Enicker said he was always fascinated by the brain and how it works.

“I also fell in love with surgery as a speciality during my rotations as a student. Exposure to neurosurgery was limited during my student days, however, I knew early on that this is what I wanted to do and every step I took from then onwards was aimed at achieving this goal.”

He qualified as a neurosurgeon in 2010, after passing his FC Neurosurgery exams.

“I then registered with the Health Profession’s Council of South Africa as a Specialist Neurosurgeon and I have been practising since. I completed my Masters (Neurosurgery) in 2016 and was appointed Head of Department of Neurosurgery at the University of KwaZulu-Natal in 2018.”

How does Enicker juggles his demanding work life and family?

Enicker said it is always hard to find a balance between family time and work, but it’s all about setting priorities and the rest takes care of itself.

Being married to a wonderful woman who is a great source of support for him and also a doctor also makes it possible to juggle the two. Enicker is married to Dr Zanele Nkosi- Enicker who is a Specialist Radiation Oncologist in private practice in Durban. They have two children (Lisolethu and Nala).

“When I am not working I spend quality time with my family, go to the gym and socialise with my friends and extended family. I also enjoy reading medical journals to keep up to date,” he said.

What is a brain tumour, what causes it and what are the symptoms?

A brain tumour is a mass of abnormal cells that develop in the brain. It can either be benign (non-cancerous) or malignant (cancerous). Brain tumours can either be primary (originating from the brain) or secondary (metastatic), meaning the tumour starts in other parts of the body and then spreads to the brain.

The symptoms vary and depend on the size and location of the tumour. They range from headaches, personality changes, visual disturbances (double vision, blurred vision and blindness), seizures, sensory changes, weakness of the arms or legs, nausea and vomiting.

Enicker goes into the detail about the operation

The operation performed was called an awake craniotomy.

Awake craniotomy is a type of neurosurgical procedure during which a patient is awake during the removal of a brain tumour. To access the brain and remove the tumour a piece of bone is cut on the skull (craniotomy). The piece of bone is fixed back in place once the procedure is complete.

It is preferred technique when you have tumours which involve the eloquent or near eloquent areas of the brain. These are areas that perform vital functions and if  removed will result in paralysis, sensory or speech problems.

The brain has no pain receptors and does not feel pain. The meninges (membranous coverings of the brain) and the scalp all have pain receptors. Local anaesthetic drugs are used to numb these areas.

Pre-operatively a thorough neurological examination is performed, while also assessing the patient’s baseline function, as well as the ability to tolerate an awake craniotomy.

We perform extensive counselling of patients regarding the procedure in order to allay anxiety and to ensure a co-operation, as this is vital in achieving successful outcome.

The surgical procedure has to be tailored to the individual case and needs.

In our case the patient was a Jazz musician (Bass Guitarist) and it was important to him to be able to continue creating music and play the guitar, hence we asked him to play during the operation, as part of tailored testing to ensure that we were able to preserve this function.

The tumour was located in the right motor cortex, affecting his ability to use the left hand.

He was an ideal candidate for an awake craniotomy in order to maximize resection while, preserving function.

We also used tiny probes on the brain (cortical stimulation) to map out functional areas to prevent neurological deficits i.e. cortical mapping.

The tumour was removed using an ultrasonic aspirator.

To a successful outcome a multidisciplinary team was required, and in our institution this involves: neurosurgeons, anaesthetists, neurologists,neurophysiologists and neuro-trained theatre nurses.