Playing the violin during brain surgery

Edited: February 19, 2020, 7:36 AM · https://www.bbc.co.uk/news/av/uk-england-london-51557044/patient-plays-violin-during-her-brain-surgery

The patient is a violinist in the Isle Of Wight Symphony Orchestra, in the UK.

Replies (18)

February 19, 2020, 7:47 AM · I used to be involved with this kind of surgery, trying to develop electrophysiological techniques that would show the surgeon exactly where he was in relation to the vulnerable sensory and motor areas. Historically there are those famous studies where surgeons would stimulate brain regions with small electrical currents to see whether and which parts of the body twitched! Unfortunately nothing we came up with was really reliable enough for the patient to be able to stay asleep throughout. I can't really see the point of being so specific as to get the patient to play the violin when simple instructions to move the limbs would provide the relevant information.
February 19, 2020, 8:01 AM · "Weird flex, but ok"
February 19, 2020, 8:40 AM · The original TV news broadcast finished with a brief interview with the lead surgeon (not on the posted video, unfortunately) who remarked that it was interesting and instructive to see how the signals from the brain varied according to how the patient was controlling the bow and her left hand fingers.

Before the operation, the surgeon asked the patient whether she was left- or right-handed. She said that she was right handed, whereupon the surgeon said that he would be careful when working near the left side of the brain which controls the right hand and arm. The patient responded that, being a violinist, her left hand was extremely important to her, and could she remain awake and play her violin during the operation. The surgeon agreed. She was given general anaesthesia for the first part of the operation (getting access to the brain, etc) and then was woken up to play the violin while the surgeon was removing the (benign) tumour, which was in the right frontal lobe. Her head, of course, was clamped in a fixed position during all this. The brain itself does not feel pain.

The televised news item also showed the patient at home playing the violin fluently not long after the operation.

February 19, 2020, 9:18 AM · I can see why she was concerned. Maybe they would have kept her asleep if she hadn't mentioned her playing. With the tumour in the right frontal lobe there should have been no danger to the right arm.
February 19, 2020, 9:20 AM · We need one of those labeled brain charts.
1. no-vibrato thirds
2. left-hand pizz
3. Viotti bowing
4. fingered tenths
etc.
February 19, 2020, 10:27 AM · Violinists are alleged to have an expanded sensory area representing the left hand but I think the evidence for that is only from non-invasive imaging of blood flow. A missed opportunity to poke around some more!
February 19, 2020, 11:00 AM · I think people staying awake during brain surgery is quite common, isn't it, so that they can get a better idea of the geography of what they are working on?
Edited: February 20, 2020, 6:50 AM · This raises some interesting viomedical and other possibilities:

- Heart surgery for violinists who play without emotion.
- Dental surgery for violinists who have problems with their bridge.
- Bladder surgery for violinists who have trouble playing with the flow of the music.
- Haircuts for violinists who have too much horse-hair on the bow.
- A newer car for violinists who have trouble shifting.
- A new keychain for violinists who can't find the right key.

Did I miss any?......

February 20, 2020, 7:13 AM · For anyone that has knowledge of this type of surgery, I have often wondered ;
How does the surgeon know when they’re straying onto dangerous territory without damaging that tissue?
Edited: February 20, 2020, 8:16 AM · First, Sander, you have misnamed three. One's hair SURGERY, proper medical name trichotomy (from thrix/trichos meaning hair and tomos meaning cutting), and the last two are transplants and should have been so named. But additionally:
- A pacemaker, for violinists who can't quite keep up with the pace;
- A Stent, for violinists not yet quite ready for a full Stentor;
- Stainer, for use in microscopy.
February 20, 2020, 7:33 AM · Rosemary - that's the big question. The functions of the cerebral cortex are distributed according to a "homunculus" i.e. a rough map of the human body and sense organs, and although there are anatomical landmarks associated with the convolutions of the cortex that provide useful clues the exact position of the sensori-motor area concerned with the hand is often ambiguous. That's why these operations are often performed with the patient awake, and why the likes of me get conscripted to help by stimulating the cortex to see what moves or what the patient feels. Areas in front of the motor cortex are generally regarded as "non-specific"and therefore non-critical, although that simply means we don't know in any detail what they do!
February 20, 2020, 8:05 AM · Thank you Steve. I guess more specifically , how can the patient tell that the surgeon is getting close to the motor area for the R hand before the bow clatters to the surgery floor?
February 20, 2020, 10:21 AM · We try to establish the location of the motor area by stimulation before the surgeon reaches for the scalpel or ultrasonic aspirator, whatever they use these days (my experience is about 15 years old and recollection a bit hazy!). The patient shouldn't feel anything as the tumour is being removed, but if the bow starts to wobble or the fingers stop moving the surgeon should know to back off and go carefully to minimise the risk. A lot depends on how well-defined the tumour is; encapsulated is best but an infiltrating tumour may be impossible to remove completely without causing a degree of motor deficit.
February 20, 2020, 11:13 AM · Sander wrote, "Heart surgery for violinists who play without emotion."

No, what you'd need is a time machine so that you can go back to the age of 13 and gather another helping of "life experiences" to inform the emotional content of your playing.

February 20, 2020, 8:55 PM · Here's the big question:
Who has the harder job? The surgeon, or the violinist?

We do know which one is more likely to have the Beechcraft...

February 21, 2020, 8:55 AM · Steve, many thanks for your posts. They have the information and background I was looking for.
February 21, 2020, 3:10 PM · Did she say it was a no brainer? ;-)
February 23, 2020, 6:57 AM · I recall reading an article which said that surgeons perform better when classical music is being played in the operating room, so I can see violin players taking it upon themselves to ensure that that happens.

Other musicians object to violinists getting the media attention again. Viola, cello, and double bass players must be thinking "I gotta get me some brain surgery and be in the news too."

Brass players suggest that their instruments might be problematic and suggest that they can drink beer during surgery, because both require careful breath control.

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