Tag Archives: Dr. Johnathan Engh

Awake Craniotomy with the Lexington Medical Center Brain Tumor Program

Inside an operating room at Lexington Medical Center, Karen Adkins had surgery to remove a tumor from her brain – while she was wide awake.

As Johnathan A. Engh, MD, FAANS, of the Lexington Medical Center Brain Tumor Program worked to remove the astrocytoma invading the supportive tissue of her frontal lobe, Karen kept up a lively conversation with one of the nurses in the surgical suite.

Karen Adkins kayaking on Lake Murray

“She asked me about my brothers and sister, where I grew up and what street I lived on,” Karen said. “She asked me to blink, move my face and stick out my tongue. We also talked about how we were both redheads.”

The procedure Karen was having is called an awake craniotomy, a type of surgery where a piece of the skull is temporarily removed to access the brain and then the patient is woken up during surgery.

When a tumor is near a part of the brain that controls critical functions such as speech, language or movement, an awake craniotomy is beneficial.

“While being kept comfortable, the patient can talk, move an extremity of interest, or name objects on a screen,” Dr. Engh said. “It allows the neurosurgeon to track the patient’s motor function and speech in real time during the operation.”

That helps doctors avoid hitting nerves that control key functions. The frontal lobe – where Karen’s tumor was located – controls speech and motor function. Damaging those nerves could lead to permanent disability.

Dr. Johnathan Engh

“Awake craniotomy allows us to work in functional regions of the brain while keeping track of the patient’s neurologic state. As a result, we can remove brain tumors that would otherwise not be safely removable,” he said.

And because brain tissue does not have pain fibers, patients don’t feel pain as doctors remove the tumor.

Awake craniotomy is one of the many surgeries performed in the Lexington Medical Center Brain Tumor Program. It’s something Karen needed after being diagnosed with a brain tumor in the summer of 2019.

The Diagnosis
Karen was a 49-year-old Irmo wife and mom who had just retired from a career in vocational rehabilitation. She enjoyed spending time kayaking on Lake Murray.

Karen had no idea a tumor was growing inside her brain until she suffered a seizure one night at home. Her husband Lee described what he saw.

“Her eyes were wide open. She was on her back and very limp,” he said. “That was extremely scary.”

Tests at Lexington Medical Center revealed a low-grade astrocytoma, a type of tumor that begins in cells called astrocytes that support nerve cells. Symptoms can include seizures, nausea and headaches.

“With a low-grade tumor, it’s very common for patients to suffer a seizure, but no other symptoms,” said Dr. Engh. “The brain is a complex circuit with billions of nerves that transmit signals to each other at different times. If something disrupts those connections – such as a fever, infection, or tumor – a seizure can occur.”

Dr. Engh was confident he could remove the whole tumor with an awake craniotomy.

“After Karen’s surgery, an MRI revealed the entire tumor was gone,” Dr. Engh said.

Brain Tumor Program
“The human brain is driven by trillions of electrical currents transmitted from specific areas to others at set times in order to create consciousness,” Dr. Engh said. “It’s estimated that the brain contains 100 billion neurons, cells that make up the electrical wires of the circuit. The number of connections between these wires is even greater.”

Despite this incredible complexity, the symptoms of brain tumors are often vague and non-specific. They include headache, confusion, weakness, changes in personality and seizures.

“With a multi-disciplinary team at Lexington Medical Center, the level of expertise and specialty is there for everything we need to do and to have all the pieces in place,” Dr. Engh said.

In fact, Dr. Engh has patients travel from around the country for him to operate on them at Lexington Medical Center. Patients have come from as far away as Washington.

Life After Brain Surgery
Karen has a new perspective after having a brain tumor.

“The three best days of my life were the day I got married, the day I had my son and the day I came out of brain surgery with Dr. Engh,” she said.

These days, Karen has routine visits with Dr. Engh to make sure her tumor is not trying to come back.

“Patient cooperation and commitment to care is so important,” said Dr. Engh. “Be willing to go to your doctor and have the appropriate scans and follow up.”

And she appreciates things more. She’s back in her kayak on Lake Murray, which Dr. Engh says is good medicine.

“The patients who do the best are the ones trying to live their lives to the fullest.”

Could It Be A Brain Tumor?

by Johnathan A. Engh, MD, FAANS, of the Lexington Medical Center Brain Tumor Program

The thought of a tumor is scary. A growth inside the body that doesn’t belong, whether benign or malignant, can cause a number of health problems. But brain tumors are especially frightening because they disrupt function in the area of the body that makes us who we are.
The human brain is driven by trillions of electrical currents that are transmitted from specific areas to others at set times in order to create consciousness. You can think of the brain as a complex circuit, which generates specific electrical impulses that create movement, speech, and even thought. This circuit is astonishing in its complexity. It is estimated that the brain contains 100 billion neurons, cells that make up the electrical wires of the circuit. The number of connections between these wires is even greater.

Despite this incredible complexity, the symptoms of brain tumors are often vague and non-specific.

Common presentations include:
•Changes in personality

The symptoms are typically not subtle, and usually progress over time. The changes can be so dramatic that a number of people with brain tumors are initially misdiagnosed with strokes. However, proper brain imaging with computed tomography (CT scans) or magnetic resonance imaging (MRI) can usually confirm the presence of a brain tumor if a patient is experiencing these symptoms.

Most headaches that we experience are NOT from a brain tumor. Headaches from brain tumors are almost always different than the headaches that most of us are used to experiencing from time to time. Headaches that are more severe than usual, associated with vomiting or passing out, worse in the morning or associated with confusion usually warrant investigation with further imaging.

Confusion can be caused by many things, including drug side effects, electrolyte disturbances, sleep disorders, and aging, to name a few. When confusion is caused by a brain tumor, family and friends may witness progressive behaviors that are unusual or bizarre and out of character for the patient. When these behaviors escalate over a period of weeks or even months, patients are usually brought in for evaluation. The same is true when patients experience personality changes from a brain tumor.

Weakness from a brain tumor is the symptom most often misdiagnosed as a stroke. Similar to a stroke victim, brain tumor patients may present with facial, arm, or leg weakness, usually on one side of the body, and often in combination. But, unlike stroke patients, tumor weakness tends to be progressive rather than sudden, and does not tend to improve at all without intervention.

Seizures are uncontrolled bursts of electrical activity from the brain that may manifest as staring spells, bouts of confusion and word slurring, or even convulsions. Sometimes seizure may be the only sign indicating the presence of a brain tumor. After medication is given to control seizures, brain imaging can delineate the tumor causing the seizure problem. In general, safe tumor removal is the best way to prevent further seizures in these cases.

The Lexington Medical Center Brain Tumor Program, led by Dr. Engh, combines the expertise of talented specialists with the most advanced and effective treatment options to help patients achieve the best possible outcomes.

222 East Medical Lane, Suite 200
West Columbia, SC 29169


Brain Surgery at Lexington Medical Center

Amelia travelled thousands of miles from the Pacific Northwest right here to West Columbia, South Carolina for Dr. Johnathan Engh of Lexington Brain & Spine Institute to perform brain surgery that would save her quality of life. She shares her story in this video below.


Amelia is 27-years-old and lives in the state of Washington. In 2008, she passed out – and when she woke up, she had a droopy face and a hard time talking. The next day, she learned she had a brain tumor.

Amelia at home in Washington

She was diagnosed with a rare, deep-seated brain tumor called a colloid cyst – a bag of cells that secrete fluid and take up space disrupting the internal plumbing system of the brain. There’s no medicine or radiation to treat it. Neurosurgeons advised Amelia to just monitor it. Unfortunately, the cyst grew over the years.

Amelia started having some vision problems, balance issues, and increased headaches and migraines.

She had to find a neurosurgeon capable of doing a procedure to remove the cyst. Of the people who have brain tumors, less than two percent have a colloid cyst.

She did extensive homework and found Dr. Jonathan Engh – reviewing everything from his scientific journals to recommenadations from patients. Dr. Engh works at Lexington Brain & Spine Institute, a Lexington Medical Center physician practice.

Amelia and Dr. Engh at Lexington Medical Center

Dr. Engh has performed approximately 100 colloid cyst removals – which is a lot considering how rare they are.

On January 31 of this year, Amelia flew from the Northwest to the Southeast part of our country to go under the knife of Dr. Engh. The operation was successful.

Back in Washington, Amelia says she now has energy and clarity of mind – picking life back up and enjoying it more than before.

Once Dr. Engh was able to make his way through the brain to the colloid cyst, he then sucked out the contents of the cyst which decompressed it into a bag. Because Dr. Engh was able to also take out that bag he considers Amelia cured.

For more information on Lexington Brain & Spine Institute, visit LexingtonBrainAndSpine.com.