By Jonny Lupsha, Wondrium Staff Writer
A patient in Rome played his saxophone during awake brain surgery. Doctors asked him to perform in order to gauge their progress on excising a tumor from his brain. Awake craniotomies are common medical practice.
In a hospital in Rome, a patient undergoing awake brain surgery made an unusual choice for passing the time: playing his saxophone. In addition to keeping him occupied for the nine-hour operation, the performance helped doctors ensure they hadn’t interfered with any part of his brain as they cut out a tumor from it. Any error in playing could be attributed to the surgeons probing areas that needed to be left alone.
Different types of brain tumors call for different approaches. In her video series Understanding Disorders of the Brain, Dr. Sandy Neargarder, Professor of Psychology at Bridgewater State University, explains how and why awake craniotomy, or awake brain surgery, is performed.
Is Awake Brain Surgery Right for You?
“The most common types of treatment [for tumors] include surgery, radiation, chemotherapy, or a combination of these,” Dr. Neargarder said. “If the tumor in question can be reached easily—so it is not near a vital structure and/or the surgeon does not need to cut through other brain areas to access it—then brain surgery is a potential option.”
According to Dr. Neargarder, surgeons prefer an awake craniotomy if the tumor is in a location that could impact the patient’s language or motor abilities. If there’s no chance that these skills could be affected, surgeons will opt for patients to be anesthetized for the operation.
During an awake craniotomy, she said, surgeons can directly stimulate parts of the patient’s brain tissue to make sure they can be removed without affecting the patient’s mobility. Fortunately, the brain has no pain receptors, so the patient experiences no pain during the surgery.
Under the Dome
“Here’s how an awake craniotomy works: After using a variety of scanning and imaging techniques to determine the tumor’s location, the patient is scheduled for surgery,” Dr. Neargarder said. “On the day of the surgery, the patient is given anxiolytic medications to inhibit any anxiety they may be experiencing. The patient is then placed in a neurosurgical head restraint that holds the head completely still.”
After this, the patient is put under with general anesthesia so the anesthesiologist can administer local anesthesia to the skin and bone of the head and neck. The surgeon then opens the skull over the tumor and cuts away the meninges, which are the membranes protecting the brain. Then the patient is woken up and the surgeons begin stimulating certain specific brain areas to observe the effects on the patient.
“Every part of your body is represented by an area on the precentral gyrus, also known as the primary motor cortex,” Dr. Neargarder said. “If the surgeon were to stimulate the area of this gyrus that corresponds to your foot, you would twitch or move your foot. The surgeon would then know that they could not remove that part of your brain because it has a function.”
All areas of the brain have a function. However, tumors don’t give your body any functions. So doctors must stimulate different parts of the cortical tissue to determine if it’s part of the brain or part of the tumor. In other words, if the doctor stimulates part of the cortical tissue that doesn’t affect the patient at all, it’s most likely part of the tumor and can be removed without any lasting complications on the patient.
“Once the stimulation is complete and the tumor is safely removed, the skull is reattached and the skin is stitched up,” Dr. Neargarder said.
Understanding Disorders of the Brain is now available to stream on Wondrium.