Not long ago The New York Times ran an article called “The Terrible Beauty of Brain Surgery.” The author of the article, Karl Ove Knausgaard, traveled to Albania to witness surgeries performed by British neurosurgeon Dr. Henry Marsh.
Not only did Mr. Knausgaard watch the surgeries, but he spoke to the patients during the operations.
Yes, that’s right—during the operation!
Like Dr. Marsh, Dr. Guy McKhann and Dr. Sameer Sheth here at Columbia University Medical Center/NewYork-Presbyterian Hospital specialize in a type of surgery called “awake craniotomy” or “awake brain surgery.” And yes, just like it sounds, the patient is actually awake during the surgery. Dr. McKhann is a longstanding friend and colleague of Dr. Marsh; in fact, he trained under Dr. Marsh at Atkinson Morley’s Hospital in London in the 1990’s.
The brain is a complex and delicate organ. Sometimes a tumor will grow in or near a part of the brain called “eloquent cortex.” These are areas that control vision, speech, sensation and movement. The neurosurgeon’s goal is to remove as much of the tumor as possible without affecting any of these important functions. The trouble is that these spots are not clearly mapped out in the brain. So how can Drs. Sheth and McKhann be sure they are not damaging one of these very sensitive areas?
They ask the patient.
Awake brain surgery actually starts out with the patient asleep. While the patient is under anesthesia, an area of the skull is removed, so that the neurosurgeon can access the brain.
Then the patient is awakened. As the surgeon probes the areas around the tumor, he and his surgical team talk to the patient. The brain itself does not feel pain, so this process may be unusual, but it doesn’t hurt.
Before they begin to remove the tumor, Dr. McKhann and Dr. Sheth make a map of the patient’s brain. The surgical team asks the patient to move a particular part of her body, or they give her a list of words to recite, or a picture to identify, while they stimulate an area of her brain associated with that task.
If the patient starts to have trouble performing the tasks, Dr. McKhann and Dr. Sheth know they have found a critical area to avoid. They mark these areas on a digital image of the patient’s brain, giving them a map of where it is safe and not safe to operate.
During the surgery they constantly re-test to make sure they stay in that safe zone, giving the patient more tasks to perform. The patient actually gets to help guide the surgeons around his or her brain!
This type of surgery takes expertise and a delicate hand, but like Dr. Marsh in The New York Times article, Dr. McKhann and Dr. Sheth have both, along with a wealth of experience. Yes, being awake during your own brain surgery may sound outrageous, but for some brain tumor patients it’s a no brainer.
You can read more about Dr. McKhann’s experiences with awake brain surgery in the following articles:
Dr. Sheth uses brain mapping in a type of surgery called “deep brain stimulation.” You can read about some of his experiences with brain mapping and deep brain stimulation in these articles:
Photo Credit: © vchalup/Dollar Photo Club
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