Wide Awake and Having Surgery
October 08, 2019
Would you ever consider having brain surgery while awake? While it sounds crazy or terrifying; it may also save your life.
Researchers at Yale-New Haven's Smilow Cancer Hospital say there are significant benefits to a procedure they developed known as an awake craniotomy.
The team behind the procedure recently allowed reporters from FOX61/WTIC, a FOX affiliate serving the New Haven-Hartford, Conn., area, into the operating room to see the procedure for themselves.
When they entered the operating room, the news team observed surgeons working to remove a tumor from the brain of a patient, Andy, a 31-year-old nurse, husband and father of two.
Andy is also a professionally trained singer and sang at the famed Carnegie Hall two years before. But, since being diagnosed with brain cancer, his life had changed significantly. His ability to sing was also threatened, as his tumor was located in the part of his brain that controls speech - and singing.
The goal of his surgeons that day was to remove as much of the tumor as possible, but with as little impact to the side of Andy's left temporal lobe as possible to reduce negative consequences to his ability to speak and sing.
About 20 minutes into the surgery, the attending anesthesiologist started to wake Andy up. He was fitted with a microphone, and the entire operating room listened in to see what the patient was going to say.
"I do have a headache. I was telling you earlier, I don't know if it's from the brain surgery or the fact that I haven't had a cup of coffee this morning," he joked.
While he was awake, a neurophysiologist in the room began to talk to him. She said a sentence and asked him to repeat it. The neurophysiologist played a vital role for Andy; she relayed changes in him to the neurosurgeon.
On the neurophysiologist's cue, the neurosurgeon removing the tumor began her work, focusing hard to excise as much of the tumor as possible.
As if removing a brain tumor wasn't tricky enough, it had to be cognizant of tiny language fibers wrapped over the tumor.
The extra risk is why the awake approach was used. During the awake procedure, Andy was constantly monitored through questioning. At one point, his neurosurgeon asked him, "What do you do in a chair?"
The neurophysiologist monitoring Andy responded that Andy was a little confused. This was a signal to the surgeon it was time to stop - despite possibly leaving a little bit of tumor behind - to help reduce life-altering post-surgical complications.
"Every surgery has risks, and those procedures that involve the brain have even greater risks," said Dr. Faisal R. Jahangiri of AXIS Neuromonitoring in Richardson, Texas.
While AXIS was not involved in Andy's case, the company is often present in the operating room during brain procedures. Technologists from AXIS work alongside surgeons.
"We provide an extra layer of patient protection in the operating room by helping the surgeon in mapping of the motor, sensory and language areas of the brain and giving surgeons real-time updates," Jahangiri said.
Being aware of how an action could lead to a patient's inability to move an arm, lift a leg, speak and even sing is critical.
"A movement in a certain direction or accidentally removing part of the language areas or fibers connecting the language and memory areas would mean lifelong changes to how that patient lives the rest of their life," Jahangiri said.
Two days after his procedure, Andy was back home with his family. Three days after that, he was able to sing at his son's baptism.
Source: FOX 61. FOX61 Exclusive: This man is awake, and singing, during brain surgery. 23 September 2019.
