The 2023 Thundering Pickle Turkey Trot was not Tanner McIntosh’s first experience with a 5K race.
On Thanksgiving morning in York County, he expected to feel a bit sore, raise some funds for the Dillsburg Area Soccer Club, and then just go about his day. But McIntosh instead felt a sharp pain in the lower right part of his back. He completed the race and figured it was just typical soreness for someone his age.
Now 37 and residing in Lancaster, McIntosh hadn’t even thought that a brain tumor could be responsible. Before his current role, he worked on budgets for oncology clinical trials, something that, while familiar, wasn’t personal.
His friends, including Laura Hartnett from Philadelphia, hadn’t considered that either. Hartnett has known McIntosh for over ten years, having met as counselors at The Renfrew Center, an eating disorder clinic in Philly.
“I thought maybe he just needed to adjust his stretching routine,” Hartnett mentioned in an email. “I was perhaps a bit too naïve to think that someone in their 30s could face a significant health issue.”
Later that winter, while skiing in Maine, the pain returned, and this time it was worse. McIntosh’s primary care physician recommended physical therapy, but that didn’t help.
“I can’t really describe it,” McIntosh said. “It was just so intense and so unlike anything I’d felt before.”
By spring 2024, he began dealing with back spasms that would make it hard for him to move and talk for half a minute at a time. Speaking required a lot of effort on his part. Following these symptoms, his doctor suggested a brain MRI.
The results revealed a mass near the primary motor cortex, the brain area that controls voluntary movement. This finding qualified McIntosh for a unique procedure at Penn Medicine Lancaster General Health: their first awake craniotomy.
Awake Craniotomies
Penn Medicine, overseeing multiple medical facilities in Pennsylvania, conducts several awake craniotomies each year, primarily to remove brain tumors.
“Most of the brain is actually quite accessible for surgery since it’s part of a connectivity network,” said Dr. Eric Hintz, a neurosurgeon at LGH. He likened the process to removing a single power line from Lancaster city.
However, when tumors affect areas crucial for speaking, moving, or seeing, surgeons might need the patient to be awake during the procedure.
During an awake craniotomy, surgeons first apply local anesthesia, remove a part of the skull, known as a bone flap, and then wake the patient to assess their verbal and motor functions while stimulating regions of the brain. If a patient can speak or perform movements, it indicates that the team is on the right path.
Although Hintz had experience performing awake craniotomies elsewhere, he had yet to do one in Lancaster County. That changed after McIntosh’s doctor referred him to Hintz’s team in summer 2024.
‘A Good Candidate’
Not everyone qualifies for an awake craniotomy, even if their tumor is in a tricky spot. Fortunately, McIntosh was not among those at risk.
“In many ways, Tanner was an ideal candidate,” Hintz noted.
McIntosh was young and relatively calm—traits that were advantageous for a successful removal of the tumor. Since anesthesiologists can’t use a breathing tube in patients undergoing this procedure, candidates must be fit enough to breathe on their own.
Moreover, the patient needs to be mentally prepared to have a surgeon operate on their brain while they’re conscious.
“I’ve had patients refuse in the past, overwhelmed by the prospect,” Hintz said. But McIntosh was up for it. Having previously worked with Penn Medicine as a financial coordinator, he had observed surgeries and felt assured in the team’s capabilities. He didn’t want to delay treatment in case it turned out he needed surgery later.
“I didn’t have any second thoughts about going ahead with it, so we just moved forward,” McIntosh said. “Why not?”
His partner, Joey Fellenbaum, attended the appointment at the Ann. B. Barshinger Cancer Institute where the awake craniotomy was presented as an option. While McIntosh didn’t hesitate, Fellenbaum admitted feeling shocked.
“I had never heard of this as a possibility,” Fellenbaum said via email.
In preparation, McIntosh met with Dr. Jesse Main, a neuropsychologist at LGH, who helps patients grasp how brain issues might affect their behavior and emotions.
Main explained what to expect in the operating room and described sounds McIntosh might hear during the procedure. They worked on speech and movement tasks McIntosh could be asked to perform during surgery, like basic finger movements and mimicking the action of using a screwdriver.
Meanwhile, Hintz was busy studying McIntosh’s brain to have a comprehensive understanding of the tumor before the procedure. He knew that once surgery began, he wouldn’t be able to rely solely on pre-operative imaging, as the brain is not exactly color-coded.
“A tumor can look a lot like the healthy tissue around it,” Hintz said. “At some point, you’ll just have to depend on your clinical judgment.”
The Awake Craniotomy Program
There was a lot more to setting up Lancaster General Health’s awake craniotomy program than just acquiring the right tools. Dr. Jesse Main, part of McIntosh’s care team, explained that awake craniotomies have been discussed within LGH’s brain disease team for a while.
Dr. Eric Hintz had prior experience with these surgeries but not in Lancaster. He noted that they were emphasized during his training.
Penn’s doctors perform awake craniotomies more frequently—one of Hintz’s colleagues averages one every two weeks. Therefore, the LGH team traveled to Philadelphia to observe and receive training, including the anesthesia team, who must monitor the patients’ breathing closely since they can’t use an intubation tube.
“Tanner’s surgery was the result of months of meticulous planning and coordination with our Philadelphia counterparts,” Hintz stated.
On the day of McIntosh’s operation, members of Penn’s neurosurgery team traveled to Lancaster, ensuring everything went smoothly. Dr. Nduka M. Amankulor, the head of neurosurgical oncology for Penn Medicine, also participated.
The Surgery
Although McIntosh was awake for part of the surgery in December, he doesn’t remember much—mainly sounds that he described as dreamlike.
At 5:27 a.m., he and his parents arrived at the hospital. His mother, Laura, felt anxious about the procedure, not knowing anyone else who had experienced it. McIntosh, being her firstborn, was someone she described as “the easiest to raise.”
Three hours later, staff wheeled McIntosh to the operating room. He made jokes, met the anesthesiology team, and learned more about the desired outcome. For the staff, it seemed like just another normal day. They gave him local anesthesia, putting him in a daze.
After numbing his scalp, Hintz secured McIntosh’s head in a clamp using three pins to prevent movement. They utilized computer software to align his scans with his actual head. Then, with McIntosh awake, Hintz drilled into the skull—something he described as a “loud, stimulating experience.”
At some point, McIntosh regained awareness, hearing clicks and voices, with Hintz examining the area. He described it as a rather strange experience.
“It felt pretty gnarly,” McIntosh described.
Main was positioned nearby, conducting tests on McIntosh’s speech and motor skills based on the exercises they had rehearsed. Given that the tumor was on the left side of the brain, impacting the right side of the body, they arranged the operating room accordingly.
“Dr. Main’s voice is like soft, velvety butter,” McIntosh said. “He has such a calming presence; it was hard to feel stressed.”
As Hintz stimulated the tissue surrounding the tumor, he instructed McIntosh to perform various tasks to monitor his functions. He vividly recalls touching his fingers together and even trying to make a peace sign.
Interestingly, McIntosh attempted to sing a song from “Wicked,” a show he had seen just days prior. He can’t recall which song, though.
“I think I talked so much that they didn’t even need to prompt me to speak,” McIntosh said. “They figured, ‘Clearly, his speech isn’t an issue.’”
Although Hintz had done awake craniotomies before, he mentioned that each instance feels surreal. Unlike unconscious patients, he had to choose his words carefully to ensure McIntosh felt at ease.
The whole surgery took under five hours, with McIntosh awake for about half of it.
“At one point, Dr. Main said, ‘You’re doing a fantastic job, Tanner. You’re doing great. This will be over in no time,’” McIntosh recounted. “And then I found myself waking up.”
What Comes Next
McIntosh spent just two nights in the hospital after the procedure, which is notably shorter than the usual five to seven-day stay suggested by Penn Medicine. He felt a mix of happiness and anxiety about going home so quickly and endured significant pain during the early recovery period.
“I had round-the-clock nursing care,” he shared, “and then it was just me and my mom at home.”
Initially, his doctors suspected he had a grade two glioma, a type of slow-growing tumor based on its progression during MRIs. However, after surgery, it turned out to be a grade three astrocytoma, a rapidly growing tumor made of astrocyte cells, which are supposed to support nerve cells in the brain and spinal cord, according to a Penn Medicine announcement.
Hintz successfully removed about 90% to 95% of the tumor, which McIntosh expressed satisfaction with.
“It’s always satisfying to look at the images and see you achieved what you aimed for,” Hintz noted.
McIntosh and his team have developed a strategy to address the remaining tumor and to prevent new cancer cells from reappearing.
Following a recovery period, McIntosh went through 33 sessions of proton therapy—a non-invasive radiation treatment using high-energy protons instead of X-rays to kill cancer DNA—over six and a half weeks.
After another brief intermission, he began a chemotherapy regimen with temozolomide, taking three capsules every morning. This treatment is administered in four-week cycles: five days on, 23 days off. On his first day of chemotherapy, he returned to his full-time role as a clinical operations manager for ICON Strategic Solutions, a healthcare consulting firm.
McIntosh is nearing the finish line, completing his sixth and final cycle of chemotherapy. His back spasms, which turned out to be focal seizures, have not reemerged. He’s made a conscious effort to reclaim a sense of normalcy, although he acknowledges that everyone is “walking on eggshells regarding cancer.” He’s spent quality time with family and friends, sharing updates through lighthearted social media posts (“Good news: I survived! Bad news: my head is still unusually large.”). He has cheered on the Eagles, enjoyed moments with his golden retriever Cooper, and visited Cape May, New Jersey, even if the summer heat—typically his favorite time—has made him feel nauseous.
In the meantime, McIntosh’s surgery has opened a new avenue for the neurosurgery team at LGH. Hintz has already completed a second awake craniotomy at LGH for a woman with a high-grade glioma in a case where time was critical. The aim was to preserve her speech abilities.
“It’s great to have this option on hand when the situation demands,” Hintz said.
After McIntosh’s last chemotherapy cycle, he’ll undergo another MRI to determine if the radiation and medication have worked. If results are positive, he can focus on recovery and redefining what “normal” looks like for him moving forward. He’ll continue with MRIs for the next decade.
“It’s never truly easy,” McIntosh reflected. “But things do improve.”
Mementos from Brain Surgery
For future patients in the awake craniotomy program at Lancaster General Health, Tanner McIntosh has a piece of advice.
“I asked if I could keep my tumor,” he said. “They said no.”
Despite the unusual circumstances of having grown the tumor himself, most hospitals have restrictions on what they can send home withpatients, particularly items considered medical waste.
“There are numerous regulations regarding biological materials and waste disposal,” Dr. Hintz explained. “Taking tissue home is a strict no.”
While McIntosh was allowed to see video footage from some parts of the surgery, he couldn’t take home any recordings showing his brain during the operation. Hintz mentioned concerns about the potential misuse of such footage.
Nevertheless, McIntosh was able to keep the radiation mask he used during his two months of proton therapy. Ultimately, he feels that the memories and stories he can share are his most treasured tokens.
“Just being able to recount these experiences is more than enough of a keepsake for me,” McIntosh said.
