in the middle of a room filled with surgeons, staff, and medical equipment, there lay the patient, softly playing scales and symphonies with her scalp cut open and her brain completely exposed.
surgeons were removing her tumour while protecting the adjacent motor cortex, which controls function of her left hand, says dr. sunit das, a neurosurgeon at st. michael’s hospital and the university of toronto. this awake brain surgery, also called an awake craniotomy, ensured that her hand movement and coordination were not damaged during the operation. because it is difficult to know exactly the areas of the brain that affect vision, movement or speech, by playing the violin, doctors were able to monitor brain activity and avoid doing damage to these areas.
an awake craniotomy is not routine but it is a common surgery in the repertoire of surgeons, says dr. das. patients are deeply sedated during the parts of the procedure that are painful and woken up once their brain is exposed.
“surgery is a painful thing. it hurts to cut the skin, open the skull and cut the dura mater, the covering over the brain,” says dr. das. “but the brain itself doesn’t have any pain receptors. i have had conversations with people where they tell me remarkable stories about their childhood and we’ve talked for hours while we’re resecting their tumour.”
in another case of awake craniotomy, neurosurgeons preserved another patient’s musical abilities by asking him to identify musical notes from an iphone during his epilepsy surgery.
courtesy of figure 1