A man recently played the saxophone during a nine-hour surgery in which doctors opened up his skull so they could access his brain and test for the safest boundaries from which to remove a tumor. The procedure is known as an awake craniotomy, and it has historically tasked patients with doing anything from playing the violin or guitar to stuffing olives so that doctors can keep an eye on their brain's function while they work on it.
The awake brain surgery on the 35-year-old musician was reportedly a success, Dr Christian Brogna told CBS News. Brogna was able to remove the tumor without any negative side effects despite it representing a complex operation.
"The tumor was located in a very, very complex area of the brain. Moreover, the patient is left-handed. This makes things more complicated because the neural pathways of the brain are much more complicated."
Being conscious in the knowledge that someone is currently inside your brain is a difficult pill to swallow, but the unusual approach to tumor removal is a way of assessing which parts of the vital organ can be cut into without losing function. Tumors and healthy brain tissue look extremely similar to the human eye, and as such separating the two puts surgeons at high risk of cutting into functional tissue that’s vital to cognitive or motor function.
Being awake during the cutting phase of the surgery means that patients have an opportunity to exhibit signs of loss of function before it’s too late. Typically, awake craniotomies involve putting patients under anesthetic while surgeons cut through the skull to get access (a process that would be excruciatingly painful to an awake patient). Then, they can work on the brain while the patient is awake as it has no pain receptors.
Surgeons can test the effects that cutting into parts of the brain will have by applying small electrical currents to stimulate the tissue. If a patient responds negatively to this area of the brain being stimulated, the surgeon knows not to cut into this part of the brain.
These tests are carried out with speech therapists who will continually test the awake patient for three types of errors relating to their speech. Error one is semantic, which means the patient gives the incorrect response when identifying an object, but the word they speak is related to the correct answer. For example, when shown a picture of a spoon the patient might say “fork”. Error two is phonemic, which means the incorrect and correct answers sound phonetically similar, for example saying “bed” when the correct answer is head. The patient is often completely unaware that they are saying the wrong words when this is happening.
The third type of error is a speech arrest, which means when trying to respond the patient loses the ability to speak entirely. This kind of error will be noticed by the patient and can be very distressing. As such, patients have to be extensively interviewed ahead of being elected for an awake craniotomy to assess if they’re emotionally able to cope with the stress of such a bizarre and unpleasant procedure.
While an invasive and no doubt anxiety-inducing procedure, operations such as this can rid people of dangerous tumors without taking away their quality of life. And if the surgeons get serenaded by a saxophone while they work? Well, that’s a bonus.