The idea of undergoing brain surgery while you're awake may seem surprising enough, but one Florida man went a step further and played guitar while doctors removed a tumor. did.
The neurology team at the University of Miami Miller School of Medicine's Sylvester Comprehensive Cancer Center asked patient Christian Nolen to help them assess and protect his manual dexterity while working as aggressively as possible to remove the tumor. I wanted them to play the notes with the instruments. .
Both the surgeon and the patient spoke to Fox News Digital about their experiences.
Nolen, an avid guitarist, had a tumor in the right frontal lobe of his brain and was beginning to experience symptoms.
“Christian was having problems with the left side of his body, specifically his left hand,” Dr. Ricardo Comotaru, director of Sylvester University's brain tumor program, told Fox News Digital over Zoom.
“He was aware that he had problems with his dexterity and that it was affecting his ability to play the guitar.”
Komotar noted that Nolen needed surgery to confirm the diagnosis, determine the type of tumor (because each tumor has different treatment options), and to remove as much of the tumor as possible.
The surgery was scheduled for 10 days after the tumor was discovered, but Nolen was surprised when doctors asked if he could stay awake and play his guitar during the surgery.
“If the tumor affects or is near a critical part of the brain (the part that controls the ability to speak, understand, or move), we keep the patient awake for continuous monitoring. We want to perform an operation, so we can see if it starts to violate the normal state of functioning of the brain,” Komotar said.
Doctors say the surgical team can't get feedback when the patient is asleep.
“Surgery is actually much more dangerous because you are removing tumors that are involved in normal brain function and can unknowingly cause real harm,” he says.
Given the importance of Nolen's guitar playing to his quality of life, Komotar said there is “no better way” to monitor Nolen's manual dexterity and the effects of the tumor than to have the instrument in the operating room. Told.
When doctors presented Nolen with his options, he said, at first “it didn't seem real.”
“I had never actually heard of a procedure of that nature being done on a show or movie,” he told Fox News Digital in an email. “This was such a unique experience that I felt I couldn’t pass up, especially since my athletic ability was at risk.”
He added: “The risks of being sedated throughout the surgery outweighed the fear and anxiety of the surgery itself.”
Before the surgery, Nolen said she was introduced to a member of the surgical team and given a detailed explanation of what would happen.
The anesthesiology team put Nolen to sleep in preparation for the craniotomy, but he woke up during a delicate part of the two-hour surgery. After he realized what was happening, the care team gave Nolen a guitar and asked him to play.
“It was very overwhelming to wake up, see everything around me, and fight my natural reaction to sit down,” Nolen recalls.
He said it took Nolen just a second to remember what was happening after a member of his care team offered him a “reassuring hand” to prevent him from getting up. .
“I just needed to breathe and calm down,” he said.
During the surgery, he tried his best to play some of the songs he had been practicing, including songs by artists such as Deftones and System of a Down.
As surgeons removed the tumor, they continuously monitored Nolen's hand function while he played the guitar.
“As we were finishing the treatment at the deepest part of the tumor, we noticed that his hand function was starting to decline,” Komotar said. “The tumor was touching and interfacing with the part of the brain that controls hand movement. Fortunately, we were able to remove the entire tumor and did not damage the hand.”
“This is outrageous,” Nolen said during the surgery.
What you need to know about the awake procedure
Although it's not routine for patients to play the guitar during surgery, Komotar told Fox News Digital that he and the rest of the specialized neurosurgery team play guitar several times a week, totaling hundreds of times a year. He said he was undergoing lower surgery.
“Most patients are interested in the process,” he says. “We tell them to always be available for testing as they are able to speak and move their arms and legs.”
Doctors also reassure patients that they will not feel any pain, will likely not remember the entire procedure, and will remain very comfortable. “This is the result of our world-class neuroanesthesia team,” Komotar added.
Studies have proven the benefits of performing the procedure under awake anesthesia rather than deep general anesthesia, the doctor said.
“Surgery with continuous neurological examination leads to better functional outcomes and fewer neurological deficits,” he said.
Evacuation and recovery are also improved.
“The lower the amount of anesthesia used during surgery, the better the patient will be awake,” he said. “The earlier you wake up, the earlier you get up and walk around, and the sooner you get home.”
Dr. Komotar added, “And essentially, the longer you stay in the hospital, the more complications you have.”
Playing the guitar isn't the only activity patients can do while awake.
Komotar said anything that doesn't put pressure on his head, like playing the violin, is fine.
Some patients sing during brain surgery, allowing surgeons to monitor their ability to form and understand words when removing tumors in areas associated with language.
Komotar acknowledged that awake cranial surgery comes with some risks.
“Performing the surgery while awake can definitely make the seizure worse,” he told Fox News Digital. “For people with a history of seizures, we try to avoid electrical brain stimulation, which is part of the technique.”
The biggest risk of performing awake brain tumor removal is that about 5 to 10 percent of patients “cannot tolerate” being awake, Komotar said.
“Even with world-class anesthesia, you may wake up startled or in too much pain to be tested,” he says. “They may become confused, agitated, or unable to follow commands.”
In that case, the care team puts the patient back to sleep and proceeds with a more conservative tumor removal.
Without continued feedback from patients, surgical teams would not be able to be as aggressive in removing tumors, Komotar points out. “We only take out what we know is absolutely safe and leave everything questionable.”
road to recovery
Nolen's surgery went smoothly, and the entire tumor was removed.
“Christian was great,” Komotar said. “He went home the day after the surgery. He says his quality of life is better than ever, so I think his recovery has been amazing.”
The patient said the first few weeks after surgery were a little difficult for Nolen, mainly due to post-surgery restrictions.
“These were really long days,” Nolen told FOX News Digital. “But having a strong support system has helped me focus on the positives.”
He is now back to training in the gym and playing the guitar, and his left hand has improved significantly.
He is awaiting final pathology results and will likely undergo follow-up treatment consisting of six weeks of radiotherapy and chemotherapy.
Both Komotal and Nolen emphasized that the success of the surgery depends on the cooperation of the entire treatment team.
“The team at Sylvester Comprehensive Cancer Center in Miami provided extremely helpful information and left little to the imagination in the best possible way,” Nolen said. “They also provided me with quite a program that provided me with emotional support.”
“Incidents like this shine a spotlight on the value of multidisciplinary care,” Komotar added.
“It takes a whole comprehensive team working together, including neuroanesthesiologists, great intensivists, nurses, technicians, and great oncologists, to remove tumors like this and get patients back to health so quickly. It is impossible to send him home in this condition.”
