The doctor cut open his skull and invited him to play guitar during the operation.

Image source: DALL E 3

Imagine this scene: you wake up from your sleep and find yourself lying in the operating room. The doctor next to you is talking softly, and the clanking sound of medical equipment colliding comes from above your head from time to time. You recall that you are undergoing a craniotomy, so you savor it carefully, trying to feel the surgeon's delicate operation in your brain. At this time, the nurse next to you hands you a guitar and says, "Please start your performance."

How do you feel? Panic, disgust or shock? In fact, this scene is not from a science fiction movie, but a true story that happened in a medical setting . In December 2023, American professional guitarist Christian Nolen underwent such an operation.

Nolen plays guitar while performing surgery (Photo credit: @WSVN-TV via YouTube)

Rock Operating Room

During a performance, Noren was hit by someone. He didn't pay attention to it at the time, but soon some problems arose. Noren lost sensation on the left side of his body, he could not control the parts above the waist, and his face began to droop . As a professional guitarist, not being able to move his left hand meant the end of his music career. Concerned, Noren went to the hospital, and after a series of examinations, the doctor found that he had a glioma in the right frontal lobe of his brain , which was the culprit for his various symptoms.

The medical team at the Leonard M. Miller School of Medicine at the University of Miami told Nolen that he had to undergo surgery as soon as possible to remove most of the tumor. On the one hand, this would relieve his current symptoms; on the other hand, different tumors have different treatment plans, and doctors need to get the pathological test results of the biopsy samples before arranging follow-up treatment .

So, the surgery was scheduled for 10 days later. To Nolen's surprise, the doctor asked him a strange request: Can you stay awake for surgery and play guitar while removing the tumor?

Faced with Nolen's confusion, the medical team told him that this was because craniotomy was very dangerous, especially since his tumor was very close to the critical functional area of ​​the brain. If he was not careful, it could cause damage to important abilities. If Nolen underwent surgery in a coma, it would be difficult for doctors to determine in time whether the area under the scalpel would be affected. Therefore, they hoped that Nolen could play the guitar while undergoing surgery, so that doctors could monitor the impact of the surgery on his hand flexibility in real time, ensuring that no critical areas were damaged while removing as much of the tumor as possible.

Awake craniotomy requires teamwork (Image source: Acta Neurochirurgica)

The doctor also assured Nolen that he would not feel any pain during the operation and would be very comfortable . After hearing this explanation, Nolen still felt it was unreal, as if the scenes in TV and movies really appeared in his life. However, in order to save his left hand, Nolen accepted the proposal, even though there was still a trace of fear and anxiety in his heart.

On December 18, 2023, the operation began. Under the effect of anesthetics, Nolen quickly fell into a coma. After sleeping for an unknown period of time, he vaguely felt someone waking him up, and something in his mouth seemed to be removed (actually a tracheal tube). Nolen opened his eyes in a daze and wanted to sit up and look around. Suddenly, a hand stopped him. Nolen realized that he was undergoing a craniotomy.

Before the operation, the medical team had told Nolen in detail the process of the operation and what might happen. So he followed the doctor's instructions and began to control his breathing and stay calm . The nurse handed the guitar to Nolen and told him that he could start playing. Nolen chose to play the songs he practiced daily, including the works of two American metal bands, Deftones and System of a Down.

Deftones (Photo credit: benjgibbs, CC BY 2.0, via Wikimedia Commons)

The operation went smoothly with the sound of Nolen's guitar. However, because the tumor was directly connected to the area in Nolen's brain that controls hand movement, when the doctors began to remove the deepest part of the tumor, they clearly noticed that Nolen's hand function was abnormal. Fortunately, the highly skilled doctors did not hurt this part and eventually completely removed the tumor while preserving Nolen's hand function . Afterwards, Nolen fell asleep again under the effect of anesthesia. The entire operation lasted two hours.

The day after surgery, Nolen returned home. Although the first few weeks were difficult for Nolen to follow the doctor's postoperative requirements, he has ended this time and started to work out in the gym and picked up the guitar that he almost lost. Soon, Nolen's left hand function improved significantly, and he passed the finger flexibility test (dexterity test). He only needs to wait for the pathology results of the tumor tissue and receive further treatment.

Awake craniotomy

The type of craniotomy that Nolen underwent while remaining awake is called awake craniotomy . In fact, this type of surgery is not new. As early as 1886, British scientist Victor Horsley performed awake craniotomy on epileptic patients. Since the patient's lesions need to be accurately located using cerebral cortical electrography during the operation, and anesthetic drugs directly affect the electrical activity of the nervous system, it is more conducive to the location and removal of epileptic lesions if the patient remains awake .

Later, awake craniotomy was increasingly used to remove tumors in key brain regions , including the motor cortex in the prefrontal gyrus, the sensory cortex in the postcentral gyrus, and the language cortex. These regions are not only directly related to the patient's key functions, but also difficult to image. Therefore, by observing and monitoring the various manifestations of awake patients during surgery, doctors can more directly avoid damaging important parts .

In addition, another benefit of awake craniotomy is that it uses less anesthetic, which can reduce the cost of postoperative intensive care and reduce neurological deficits. Moreover, patients recover faster and have better results after surgery . Generally speaking, longer hospital stay means more postoperative complications. Therefore, compared with ordinary craniotomy, patients who undergo awake craniotomy have a longer survival period after surgery.

At present, this type of surgery has been carried out more and more. For example, Sylvester Comprehensive Cancer Center in the United States, where Nolen performed the surgery , performs more than 200 such operations every year, an average of several operations per week . In March 2007, the First Affiliated Hospital of Xinxiang Medical College in Henan Province, China, and doctors from Toronto General Hospital in Canada cooperated to complete the first awake craniotomy in China.

Frisch plays violin during surgery (Photo credit: @MayoClinic via YouTube)

Even so, however, it is not routine for patients to play instruments during awake craniotomy . Doctors usually talk to patients during surgery, ask them to complete simple language tasks (such as word comprehension), and sometimes ask them to sing. In 2017, violinist Roger Frisch was also asked to play the violin during surgery because of essential tremor. However, unlike Nolen's brain tumor removal, Frisch underwent surgery to implant electrodes in the target brain area. Now, as long as the switch is turned on, the electrodes will send electrical pulses to specific locations in Frisch's brain, thereby changing brain activity, and he can play fluently .

You may be curious, won’t it hurt to remove a brain tumor while awake? In fact, although it is called “awake craniotomy,” the patient is not awake throughout the entire process . In the initial stage of the operation, the doctor needs to put skull nails on the patient, cut the scalp, remove the bone flap and dura mater, so the patient is usually anesthetized and unconscious at this stage. During the stage of removing the brain tumor, since the brain itself has no pain receptors, the patient will only feel the pressure or vibration caused by the surgical operation (imagine the process of extracting wisdom teeth). At the same time, during the entire operation, the patient’s head muscles, skin, dura mater, etc. are all in an anesthetized state, so there is no pain.

However, not all patients are suitable for such surgery . Mental confusion, poor compliance, and lack of concentration are contraindications for such surgery. For example, about 5% to 10% of patients may feel confused, anxious, frightened, or in pain after being awakened during surgery, and may be unable to cooperate with the instructions of medical staff for intraoperative monitoring. Therefore, if this happens during surgery, the anesthesiologist will put the patient back into a coma, and the surgical team will choose a more conservative tumor resection plan.

References (slideable)

[1] https://wsvn.com/news/local/miami-dade/out-of-this-world-man-plays-guitar-while-undergoing-brain-surgery-at-sylvester-comprehensive-cancer-center/

[2] https://www.foxnews.com/health/florida-brain-tumor-patient-plays-guitar-during-surgery-this-wild

[3] https://www.newswise.com/articles/out-with-the-old-and-in-with-a-hopeful-new-year-for-patient-who-played-guitar-during-awake-brain-tumor-surgery

[4] https://www.ncbi.nlm.nih.gov/books/NBK572053/

[5] https://journals.lww.com/rca/fulltext/2018/06002/awake_craniotomy__indications,_benefits,_and.9.aspx

[6] https://global.chinadaily.com.cn/hqbl/2007-03/22/content_833782.htm

[7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9338386/

[8] https://www.youtube.com/watch?v=sEfnHGz2mNA

[9] https://www.youtube.com/watch?v=T3QQOQAILZw

[10] https://link.springer.com/article/10.1007/s00701-016-3021-z

Planning and production

Source: Global Science

Author: Huang Yujia

Editor: He Tong