This is the sound a violin makes when it’s being played by someone who’s having their brain operated on.
Yep. This musician is awake and playing her violin in the middle of her own brain surgery.
But why?!
This is something called an awake craniotomy—and get ready for some gory details here.
So, say there’s a patient who needs to undergo brain surgery.
They’re sedated for the beginning part, where the doctor makes an incision in the patient’s scalp
and drills into their skull with specialized tools to remove a section of the bone from their skull.
And then, the patient is brought out of sedation by the anesthesiologist
so they can be conscious while the doctor operates on their brain.
Which apparently doesn’t hurt because the brain doesn’t have any nociceptors,
or the nerve cell endings that detect pain.
But again, why does the patient need to be awake?
Well, the doctor can ask the patient questions throughout the surgery,
or ask them to perform basic movements to ensure that what the doctor is doing back there
isn’t affecting any of the patient’s capabilities,
like in areas of the brain that control things like speech or finger movement.
And turns out, we’ve actually been doing craniotomies since ancient times, you guys.
The first archeological evidence of purposeful perforations of the skull
dates back to the Neolithic period.
The first written evidence we have of a craniotomy being performed as a surgery
is by Hippocrates in the 5th century BCE,
who produced guidelines for it to be used in the treatment of epilepsy,
which remained more or less common practice for the next 2,000 years or so.
The awake craniotomy heyday really began in the 1920s,
and the development of our modern anesthesia medications to be able to put the patient to sleep
for the beginning and end of the surgery have been essential, as you can imagine,
in making it a widely used neurosurgery technique around the world today.
Which brings us back to the violin.
Dagmar Turner is a violinist who was diagnosed with a brain tumor that had to be removed.
But it was in her right frontal lobe, smack in the middle of the spot in her brain
that controls the coordination in her left arm and hand—
which, you know…is what you use to play the violin.
To make sure he was keeping these parts of her brain safe,
the brain surgeon asked Turner to play her instrument while he was operating on her.
How amazing is that?
But at the same time, it does still seem a little primitive, right?
I mean, these surgeries can take hours, and the patient has to stay awake
the whole time the surgeon is fiddling around in there.
Like, is this still the best way we currently have to give patients better outcomes
if their tumor is in an area near speech and motor centers?!
Well, it’s a little more advanced than that these days,
because doctors are able to map brain activity before surgery using something called functional MRIs,
which lets them go into surgery with highly specific information about that patient’s individual brain.
This is actually what they did for the violinist’s tumor.
But fMRIs are also not a perfect solution,
because they don’t get the clearest picture of what’s going on to begin with.
And plus, the brain can actually shift during surgery.
I mean, it is basically just a hunk of really complex jello sliding around in brain juice in there,
which makes my head feel kinda…*funny face.*
Enter the next step up in brain surgery sophistication: intraoperative MRIs.
These are devices in specialized operating suites that let doctors take real-time MRIs
during the brain surgery.
They can basically stop at certain intervals to see what’s going on with the brain during the procedure.
Surgeons use it to help them tell the difference between the tumor and healthy brain tissue,
and to make sure they’re getting all the edges of the bad stuff that needs to be removed.
But can we get even better?
Some doctors think so, and are making strides with even more advanced brain mapping techniques.
One of those involves placing a grid of sensors directly on the brain.
These sensors detect and measure electrical signals and then the accompanying computer program
puts it all together to give the surgeons a digital map of the brain they’re working on.
And now we’re using robotics involved in neurosurgery, you guys.
Robots are helping brain surgeons give patients better outcomes in all kinds of ways,
including a robot that can operate inside an MRI machine,
which would give the robot—and the doctor—a real-time look at what’s going on in the brain
as they perform incredibly delicate manipulations of brain tissue.
Brain surgery is gettin’ even more complicated—but also better.
Awake craniotomy has been used for thousands of years for a reason,
and it’s because it does a pretty good job of making sure that brain surgery goes as smoothly as possible.
And brain surgeons are looking to use it,
and the accompanying advancements that make it even more precise and even more safe,
to find better treatments for conditions like epilepsy and Parkinson’s disease.
And there’s good news from the violinist!
Doctors removed over 90% of her tumor,
and all of the especially aggressive areas,
and she still has total function of her left hand.
So, Turner will be playing the violin for a long time to come.
If you guys found those tidbits of science history cool, then boy have I got the show for you.
Go listen to Surprisingly Brilliant, my new podcast with Seeker,
all about the wonderful and weird unknown stories that have shaped science throughout history!
You can find it at the link in the description, on iHeart Radio, on Apple podcasts,
or literally anywhere else podcasts live.
Keep coming back to Seeker for all of your breaking medical tech news,
and thanks for watching. I'll see ya next time.