Playing the violin during brain surgery
The patient is a violinist in the Isle Of Wight Symphony Orchestra, in the UK.
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.
"Weird flex, but ok"
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.
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.
We need one of those labeled brain charts.
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!
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?
This raises some interesting viomedical and other possibilities:
For anyone that has knowledge of this type of surgery, I have often wondered ;
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:
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!
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?
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.
Sander wrote, "Heart surgery for violinists who play without emotion."
Here's the big question:
Steve, many thanks for your posts. They have the information and background I was looking for.
Did she say it was a no brainer? ;-)
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.
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