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Kennedy: Wide-Awake Brain Surgery
YIKES! Was there a typo in the headline? Did it really read 'Wide-Awake Brain Surgery'?!?
Warning: This is your last chance to click-away if you are squeamish!
Senator Edward M. Kennedy has undergone successful surgery at Duke University Medical Center to remove a malignant brain tumor. More precisely, the tumor was resected or debulked - not every bit was removed. Click here to read a recent WebMD blog about the Senator's situation.
Many people were surprised to learn from the neurosurgeon that Senator Kennedy was awake during portions of the surgery. Two questions immediately come to mind:
In order to perform 'awake brain surgery' the patient is sedated with a powerful, rapidly acting IV drug. Zonk! Out like a light! The patient's head is positioned and stabilized in a very snug way (enough said!)
The surgeons then use a syringe and needle to inject all of the soft tissues (skin, subcutaneous connective tissues, and periosteum) in the region of the scalp where surgery will be performed. The patient is asleep so they feel nothing! All three of these layers have delicate sensory (pain) fibers. The infiltration of long-acting local anesthetic completely numbs the area. Skin incisions and opening of the skull bone (craniotomy) are performed. There are no pain fibers in the brain tissue itself.
Guided by previous MRI scans the neurosurgeons dissect to the area inside the skull where the tumor is located. Once they have isolated the bulk of the mass they instruct the anesthesiologist to waken the patient. The flow of sedative is cut-off and the patient is gently awakened. There is no alarm or sense of panic. The patient experiences no pain whatsoever.
Here's where we talk about 'Why?'
Brain tissue is extraordinarily delicate and responsible for so many critical life functions - everything from vision to memories and everything else in between. The goal of Senator Kennedy's operation was to remove as much tumor as possible while sacrificing as little healthy brain tissue as possible. To accurately guide the neurosurgical team the patient performs a variety of wide-awake skills in the operating room: speech, movements, vision, cognition, etc. The surgeons know what activities correspond with various areas of brain anatomy. If a patient's response falters the surgeons know they are very close to a critical region and tend to back-off. Remember, the patient experiences no discomfort whatsoever.
Once all or most of the tumor is removed the sedation is once again administered and the patient drifts back to sleep. The skull bone is replaced and the overlying scalp tissues are reattached. The Senator has an amazing mane of grey hair and it will grow back quickly as soon as chemo and radiation therapy is completed.
Pathologists will study the excised tissue and collaborate with the oncology team to develop a treatment plan that will offer Senator Kennedy the best prospects for survival while maintaining a satisfactory quality of life.
Oh, one last thing. Most of these fast-acting sedatives are highly amnestic. It is doubtful that Senator Kennedy will remember anything about his visit to the neurosurgical surgery suite. If he wants to learn more about the experience he may have to log on to WebMD!
Related Topics:
Technorati Tags: brain surgery, Edward Kennedy, brain tumor, brain cancer, treatment
Warning: This is your last chance to click-away if you are squeamish!
Senator Edward M. Kennedy has undergone successful surgery at Duke University Medical Center to remove a malignant brain tumor. More precisely, the tumor was resected or debulked - not every bit was removed. Click here to read a recent WebMD blog about the Senator's situation.
Many people were surprised to learn from the neurosurgeon that Senator Kennedy was awake during portions of the surgery. Two questions immediately come to mind:
- How could he be awake for brain surgery?
- Why does he need to be awake?
In order to perform 'awake brain surgery' the patient is sedated with a powerful, rapidly acting IV drug. Zonk! Out like a light! The patient's head is positioned and stabilized in a very snug way (enough said!)
The surgeons then use a syringe and needle to inject all of the soft tissues (skin, subcutaneous connective tissues, and periosteum) in the region of the scalp where surgery will be performed. The patient is asleep so they feel nothing! All three of these layers have delicate sensory (pain) fibers. The infiltration of long-acting local anesthetic completely numbs the area. Skin incisions and opening of the skull bone (craniotomy) are performed. There are no pain fibers in the brain tissue itself.
Guided by previous MRI scans the neurosurgeons dissect to the area inside the skull where the tumor is located. Once they have isolated the bulk of the mass they instruct the anesthesiologist to waken the patient. The flow of sedative is cut-off and the patient is gently awakened. There is no alarm or sense of panic. The patient experiences no pain whatsoever.
Here's where we talk about 'Why?'
Brain tissue is extraordinarily delicate and responsible for so many critical life functions - everything from vision to memories and everything else in between. The goal of Senator Kennedy's operation was to remove as much tumor as possible while sacrificing as little healthy brain tissue as possible. To accurately guide the neurosurgical team the patient performs a variety of wide-awake skills in the operating room: speech, movements, vision, cognition, etc. The surgeons know what activities correspond with various areas of brain anatomy. If a patient's response falters the surgeons know they are very close to a critical region and tend to back-off. Remember, the patient experiences no discomfort whatsoever.
Once all or most of the tumor is removed the sedation is once again administered and the patient drifts back to sleep. The skull bone is replaced and the overlying scalp tissues are reattached. The Senator has an amazing mane of grey hair and it will grow back quickly as soon as chemo and radiation therapy is completed.
Pathologists will study the excised tissue and collaborate with the oncology team to develop a treatment plan that will offer Senator Kennedy the best prospects for survival while maintaining a satisfactory quality of life.
Oh, one last thing. Most of these fast-acting sedatives are highly amnestic. It is doubtful that Senator Kennedy will remember anything about his visit to the neurosurgical surgery suite. If he wants to learn more about the experience he may have to log on to WebMD!
Related Topics:
Technorati Tags: brain surgery, Edward Kennedy, brain tumor, brain cancer, treatment
