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February 23, 2020

BehindTheMedspeak: Patient plays violin while surgeons remove brain tumor

From the Smithsonian:

Watch a Musician Play Violin During Brain Surgery
 
Keeping patients awake during operations can help neurosurgeons avoid damaging areas of the brain that govern functions like vision, movement, or speech
 
In the fall of 2019, Dagmar Turner was told that a tumor that had been growing in her brain for years had become large and aggressive — and would require surgery.
 
The mass sat on her right frontal lobe, close to an area that controls the fine movements of the left hand.
 
The possibility that surgery might damage this part of the brain was a major concern: Turner, a violinist who plays with the Isle of Wight Symphony Orchestra, relies on her left hand to regulate the lengths of the instrument's strings, thereby producing different pitches.

Fortunately, the patient had an idea.

"I suggested, actually, that they have me play the violin during the surgery," she said.

This week, King's College Hospital in London, where the surgery was performed, released remarkable footage from the operating room.

As doctors work behind a plastic sheet, Dagmar, lying on the operating table, performs melodies on her violin.

Over the course of the procedure, she played music by Gustav Mahler, George Gershwin, and the Spanish singer-songwriter Julio Iglesias, reported Guy Faulconbridge​ for Reuters.

"Awake craniotomies," as this type of operation is known, involve the patient being alert for part of the procedure.

They're performed when tumors or epileptic seizures requiring surgery are located near parts of the brain that control functions like vision, movement, or speech.

As the patient responds to questions, makes movements, or identifies images, neurosurgeons can map the brain and avoid damaging areas that govern these functions.

Brad Mahon, a cognitive neuroscientist at Carnegie Mellon University, tells NPR's Merrit Kennedy that an imaging technique known as "functional MRI," which measures small changes in blood flow during brain activity, now lets doctors create detailed maps of the brain prior to surgery, giving them more detailed information before the procedure starts.

In Turner's case, a neurosurgical team led by Professor Keyoumars Ashkan spent two hours mapping areas of her brain that were active when she played the violin, helping them create a careful plan for the surgery.

Turner was under anesthetic while Ashkan and his colleagues performed the craniotomy, or removal of part of the skull.

She was brought back to consciousness when the tumor was being operated upon — something that might seem like it would hurt, but the brain does not feel pain and doctors numb any surrounding tissue.

Anesthetists and a therapist kept a close watch on Turner, who played away on her violin.

"We knew how important the violin is to Dagmar so it was vital that we preserved function in the delicate areas of her brain that allow her to play," Ashkan said in a statement. "We managed to remove over 90 percent of the tumor, including all the areas suspicious of aggressive activity, while retaining full function in her left hand."

While it isn't common for patients to serenade their doctors with music during surgery, Turner's case is not without precedent.

In July 2016, a music teacher played the saxophone while having a tumor removed from his brain.

Doctors have kept patients awake to preserve other important skills; Mahon said that an accountant once performed math problems during his operation.

A love for music is something that Turner and Ashkan share; the brain tumor specialist happens to have a degree in music and is an "accomplished pianist," according to King's College Hospital.
 
For Turner, the thought of losing the ability to play her instrument of choice was "heart-breaking."

"The violin is my passion; I've been playing since I was 10 years old," she says. "Being a musician himself, Professor Ashkan understood my concerns. He and the team at King's went out of their way to plan the operation. Thanks to them I'm hoping to be back with my orchestra very soon."

February 23, 2020 at 02:01 PM | Permalink


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