Wide awake during brain cancer surgery

This fascinating video from the Mayo Clinic explains how 28-year-old Mary Meixner went through "awake surgery" during which surgeons used an intra-operative MRI to target her brain tumor.

At the end of the operation, she slept. Then, she says, "I woke up and I was so excited, and I was like, yes! I'm not dead! I can talk! I can think! Because you never know, right?"

Transcript here (PDF).

(via @thespeachgal)

• [coryf]

  Hate to see anybody have to go through surgery.  However, there’s a reason why they can do it awake, there are no pain sensors in the brain itself.

• [Mujokan]

  Daniel Dennett anecdote:

  A neurosurgeon once told me about operating on the brain of a young man with epilepsy. As is customary in this kind of operation, the patient was wide awake, under only local anesthesia, while the surgeon delicately explored his exposed cortex, making sure that the parts tentatively to be removed were not absolutely vital by stimulating them electrically and asking the patient what he experienced. Some stimulations provoked visual flashes or hand-raisings, others a sort of buzzing sensation, but one spot produced a delighted response from the patient: “It’s ‘Outta Get Me’ by Guns N’Roses, my favorite heavy metal band!”

  I asked the neurosurgeon if he had asked the patient to sing or hum along with the music, since it would be fascinating to learn how “high fidelity” the provoked memory was. Would it be in exactly the same key and tempo as the record? Such a song (unlike “Silent Night”) has one canonical version, so we could simply have superimposed a recording of the patient’s humming with the standard record and compare the results. Unfortunately, even though a tape recorder had been running during the operation, the surgeon hadn’t asked the patient to sing along. “Why not?” I asked, and he replied: “I hate rock music!”

  Later in the conversation the neurosurgeon happened to remark that he was going to have to operate again on the same young man, and I expressed the hope that he would just check to see if he could restimulate the rock music, and this time ask the fellow to sing along. “I can’t do that,” replied the neurosurgeon, “since I cut out that part.” “It was part of the epileptic focus?” I asked, and he replied, “No, I already told you – I hate rock music.”

• [Alpacaman]

  This is the kind of thing you see on TV and think there is no way that can be done, it’s science-fiction-esque, but then it is done, and well, yeah, holy shit!

• [annomination]

  i would wear a helmet while roller blading, brain surgery or not!

  • [The Life Of Bryan]

    I noticed that too, but really it was the lack of wrist guards that sketched me out the most.

• [duc chau]

  Another viable option for mapping the eloquent areas of the brain is a functional MRI. Well before surgery they put you in an MRI machine and ask you questions and give you tasks to see where the brain “lights up.” Based on that they can plan better routes to the tumor and get a better idea where the tumor ends and the brain starts.

  Oh, and if anyone out there gets a brain tumor (god forbid), try not to settle for just a good hospital. They will do their best but they will not likely tell you that you’d be far better off at a world class institution like the Mayo Clinic.

• [Dane]

  This brain surgery video is relevant

  http://www.youtube.com/watch?v=0gMKKfBjmm8 

• [Lurking_Grue]

  I suppose they can tell if they are going wrong if you suddenly shout out boogity boogity cheese!

  • [Paul Renault]

    Yeah, but they know they’ve got the right spot when you smell burning toast.

    https://www.youtube.com/watch?v=kNdM9JhTPJw

• [L_Mariachi]

  How does the MRI differentiate between tumor and brain? Aren’t the cancerous cells almost identical to those they originally came from, just reproducing uncontrollably? And if it’s essentially brain tissue run riot, why doesn’t the existing brain “colonize” it the way it sometime repurposes dormant tissue to make up for nearby damage?

  • [Mujokan]

    That would be lovely, but obviously it doesn’t work that way. Just quickly looking on Wikipedia, either you have anaplasia, in which case the cells are garbage, or neoplasia, in which case there are just too damn many of them. It’s trivial to see the difference on a scan.

• [dr]

  One of the most compelling waking narratives of brain surgery was Frigyes Karinthy’s autobiographical Journey Round My Skull in 1939.  (See 
  http://50watts.com/2000085/Frigyes-Karinthy )  Karinthy is possibly best known for  coming up with the idea of “six degrees of freedom” in a 1929 short story.

• [bzshapiro]

  I actually had this surgery when I was 17 (7 years ago). I remember try to get the doctors to explain what brain actually looks like open and telling bad jokes to them for some reason.