During some brain surgeries, patients may be asked to perform complex tasks, such as playing a musical instrument. This technique, already used for various operations also in Italy, is called surgery with the patient awake (awake brain surgery) and allows doctors to monitor critical brain functions in real time to preserve the patient’s neurological capabilities, taking advantage of the lack of pain receptors in the brain. Furthermore, it allows for a more extensive removal of the tumor and a better recovery for the patient. Awake surgery is an extraordinary example of how medicine improves not only with technological progress, but also towardsattention to the patient and his psychological and social life.
Why is the brain operated on when the patient is awake?
The brain is an extraordinary organ: it manages ours languagei movementsthe memory and even there creativity. However, it has no pain receptors. This means that it can be manipulated surgically without the patient experiencing pain, as long as the surrounding areas, such as the scalp, are anesthetized.
Performing tasks such as speaking, counting or even playing during the operation allows doctors to map brain areas in real timemaking sure not to damage essential functions. This technique is particularly useful in interventions on critical areasas in the case of tumors or epilepsy, where surgical precision can make the difference between maintaining or losing vital skills.
The objective of these operations is to remove or manipulate the damaged brain areas trying to impact as little as possible on the patient’s skills, especially when these skills constitute the professional identity of the people operated on.
What happens during the surgery?
Preparation begins long before entering the operating room. Through tools like the functional magnetic resonance imaging or the transcranial magnetic stimulationdoctors map the areas of the brain responsible for the functions to be preserved.
The procedure in the operating room begins with the patient under general anesthesia. At this moment the craniotomyi.e. the opening of the skull. Once this phase is completed, the anesthesia is suspended and the patient is gradually awakened.
During surgery, surgeons use electrodes to stimulate or inhibit specific brain areas, while the patient performs activities requests. If something goes wrong – for example, the patient stops talking or playing properly – doctors know they are getting too close to a problem.critical area. This way they can operate with extraordinary precision, monitoring in real time the effects of their operations.
Play a musical instrument is an activity that involves many functions, and therefore many brain areas. Requires one coordination fine motor skills between hands, eyes and fingers, a monitoring continuous auditory to evaluate the quality of the sound, and clearly a memory musical to maintain the correct rhythm and notes. In particular cases, such as in the cases of musicians undergoing surgery to remove a tumor, playing during the operation becomes a problem crucial test to understand the effect of the scalpel on fine motor and sensory skills.
At the end of the operation, the patient comes again placed under general anesthesia for closing the skull and for the final stages of the operation.
Examples of awake surgery in Italy
In 2022 a 35 year old saxophonist he underwent surgery at the Padeia International Hospital in Rome for a brain tumor. A particularly difficult operation, given the nature of the tumor and a singular characteristic of the patient: that of being a saxophonist left-handed. This quality constitutes a term of distinction with respect to the “norm”, which therefore requires one particularly scrupulous mapping by doctors. The patient was operated on while playing by the neurosurgeon Christian Brogna, who a few years earlier had performed a similar operation on a violist in London.
In 2017, at the Sant’Anna Hospital in Ferrara, a patient was operated on clarinetist with a tumor located in the sensory cortexwith an impact on the area that receives perceptive feedback from the left hand, which is fundamental for the musician. The operation – also carried out here in awake surgery – it was a success.
Still in Italy, in 2019 a young woman 23 year old violinist had to be operated to remove a tumor mass located in the left frontal cortexwhere the areas that control the movement of the right side of the body are located, and where very important areas for language are located, such as the famous Broca’s area. The curtain that day had the green hues typical of hospital curtains as the musician began her atypical concert. Here too, awaken surgery has proven to be a fundamental technique for surgeons to best preserve the characteristics that constitute the musician’s abilities and identity.
The advantages for the patient
It is clear, therefore, that the surgery with the patient awake offers benefits extraordinary. It is the expression of medicine’s attention not only to the success of the operation, but to the preservation of neurological functions, because the patient’s direct feedback allows us to avoid irreparable damage to language, memory or movements.
Then there is one greater general safetygiven that errors are reduced thanks to continuous and immediate monitoring. Another non-negligible aspect is that a condom operation such as awaken patient surgery involves a faster recovery: personalized intervention increases the chances of resuming normal activities, including musical practice, but also a more extensive resection of the tumoreven though it may seem counterintuitive.
In operations on a patient under general anesthesia, in fact, the surgeon is forced to “remove as little as possible”, while with the patient awake the mass is removed as long as it does not affect the patient’s faculties.
