Man plays his saxophone through 9-hour complex brain surgery to remove tumor

https://www.cbsnews.com/news/saxophone-surgery-brain-tumor-italy-awake-neurosurgery/

by Vaslo • 4 years ago

176 110 4 years ago

I never quite fully grasped the purpose of having patients stay engaged during brain operations. Is it possible to undo a brain incision? If not, what good is it to know a patient's abilities are degraded after having made a cut? Is it just to mitigate compounding unexpected damage?

roflc0ptic• 4 years ago

You don’t make more cuts there

ceejayoz2• 4 years ago

It’s not binary. You go slowly, and stop if it’s starting to impact the behavior you’re observing.

SamoyedFurFluff• 4 years ago

What’s the alternative, knowing that you’re working with a system with unknown specific architecture and whose only way you can get feedback about how you’re doing is via the patient? You can stimulate parts of the brain without damaging it btw. The surgeon just needs to know what that part is specifically.

jac241• 4 years ago

You electrically stimulate around the spot with a probe where you’re planning to resect. If the patient can’t perform whatever task you’re evaluating then you know you can’t resect in that area. Generally looking for a 1cm margin between tissue you’re going to resect and a positive stim site.

Can’t undo brain cuts. CNS neurons don’t repair themselves like peripheral neurons or your skin. Generally not cutting glioma brain tumors out per se more likely to use ultrasonic aspiration to suck the tumor out piecemeal. Depends on the tumor though.

SeanAnderson2• 4 years ago

Oh, that makes sense. Cool that we can "dry run" explore with electric pulses! Thanks for explaining :)

elteto• 4 years ago

Fascinating! What is ultrasonic aspiration and how does it work?

amelius• 4 years ago

How do you know what task to evaluate?

And what if this was not a saxophone player, but a tennis player? Or both?

ayewo• 4 years ago

You seem knowledgeable about the topic.

I'm also curious as to the answer to this question [1]. Why does left-handedness make brain surgery slightly more complicated?

1: https://news.ycombinator.com/item?id=33215614

vanattab• 4 years ago

Well you can definitely stop cutting deeper if you know something is up!

locallost• 4 years ago

Others have explained, but what I've heard from a brain surgeon on TV: it's extremely delicate and they don't always know how deep they can go, so they probe bit by bit and when they notice it's having an effect they stop. The surgeon I listened to was also a gifted storyteller, it was very very impressive and inspiring. That's really a hell of a job.

throwoutway• 4 years ago

The doctor said his patient, who has been identified only as C.Z., played the theme song from the 1970 movie "Love Story," and the Italian national anthem, at various times throughout the surgery.

FWIW, it was not the entire 9 hours, but still cool though. I guess I read the headline wrong and thought it was during the whole operation

tomcam8• 4 years ago

Yeah I'd get tired of that theme within say 7.5 hours

twic• 4 years ago

On the other hand: https://www.youtube.com/watch?v=kxopViU98Xo

boomboomsubban3• 4 years ago

Though I cognitively understand why it's the case, the fact that operating on the brain isn't painful still weirds me out. Something about the part of the body that processes pain not feeling pain feels bizarre even though I can see why there'd be no benefit to having pain receptors there.

dheera• 4 years ago

Wouldn't it be excruciatingly painful to get to the brain though? Or is there a way to locally anaesthetize so that you don't feel your scalp being sliced open and your skull being cracked open?

speedylight• 4 years ago

I think that it’s less about the pain because yeah you could probably use some sort of a local anesthetic for the scalp tissue, but I can’t imagine what all the vibrations and sounds passing through skull feels like, especially when power tools are used to drill into the skull or cut out a small section.

boomboomsubban3• 4 years ago

I think it'd be one of the least painful places. The scalp is thin, and isn't overly sensitive, think of how professional wrestlers often cut their scalp on purpose. And I don't think the skull has a ton of nerves in the first place.

A relative had brain surgery for a tumor, and if I'm remembering what she said from fifteen years ago correctly she said the anesthesia shot hurt, than the rest was more a relief than anything as the tumor had been applying constant pressure for years.

pineal2• 4 years ago

The way it usually works is that we have anesthesia put the patient entirely to sleep to start and then we wake them for the sensitive part of the case when we need to perform stimulation and cognitive testing. We use local anesthetic like lidocaine and marcaine on the scalp while opening to minimize pain when temporarily awake. Then the patient goes back to sleep for closing. It’s a tough balance for the anesthesiologists to maintain —- they are as critical to the procedure as the neurosurgeon is.

noduerme2• 4 years ago

The couple of times I've woken up from anaesthesia, I was apparently pretty rambly and nonsensical for awhile. I wonder if I'd be able to play piano like that. To some extent, playing is automatic, sub-verbal for me. Maybe it would come out great and I just wouldn't remember it, but... how do you gauge the performance given that they're still coming out of anaesthesia?

While I'm asking, there's a question that's been driving me crazy since a recent colonoscopy where I was sedated with fentanyl and (? something like diazepam). I think I remember being awake and remembering most of the procedure immediately afterwards, but within about an hour I couldn't remember anything except one moment when I was in pain and shouting that I was going to explode, as a nurse put another ampule in the drip line. What's bugging me is, was I really experiencing pain like that and aware the whole time, and the drugs just erased my memory of it afterwards? Or was that just a breakthrough moment in an otherwise uneventful procedure where I felt relatively little?

agumonkey• 4 years ago

What weirds me out is that I experienced regular pain in various part of my brain. Not migraines, more like post traumatic sensations with very acute painful areas (front, back, side, center..). Is this only blood vessel nociceptors ?

tsol• 4 years ago

Those are the nerves running through your skull. That's where a headache comes from. I learned this from having years of migraines.

bjoli• 4 years ago

That dude has steel lips. I am a professional bassoon player, and playing anything for 9 hours straight would make my lips bleed.

Edit: I apparently skimmed the article too skimmily.

yur3i__• 4 years ago

I don't imagine it was 9 straight hours but like a song an hour or every half an hour

ceejayoz2• 4 years ago

Won’t have been the entire time. Just during critical points.

at various times throughout the surgery

yellowapple4• 4 years ago

Back in high school we did one of those playathon things where a bunch of us band kids basically held a 12-hour jam session as a fundraiser for something or other. About 11 of those 12 hours were cumulatively spent riffing on "Superstition". I was on trombone, and spent most of those hours improvising solos in a desperate yet futile attempt to make it not horrifically repetitive.

I still absolutely loathe that song to this day.

analog31• 4 years ago

Jazz bassist here. I'd be worried that the surgeon would go to the bathroom, or get another drink, during my solo.

actually_a_dog• 4 years ago

I know you’re joking, but I do wonder how the logistics would work if the guy played upright bass or cello.

api• 4 years ago

Sell recordings and title it “with an open mind.”

teeray• 4 years ago

Everyone will think the album art is just an elaborate illustration.

dr_dshiv• 4 years ago

I wonder what brain activity data they collected during this. I’ve been wanting to analyze intercranial EEG of people listening to music to understand the degree to which the brain directly resonates to the frequencies and envelopes of music.

chrismorgan• 4 years ago

“Moreover, the patient is left-handed. This makes things more complicated […]

There’s something bizarrely amusing about this. I’m now picturing a surgeon saying, “I’m sorry, I can’t operate on you because you’re left-handed.”

I wonder if discrimination based on handedness is unlawful anywhere. Under Australia’s Fair Work Act (for employment) and Equal Opportunity Act (for public life), you’d have to classify it in as a disability to get it covered, and I don’t know whether that’d be allowed by a judge or jury or whatever (to say nothing of sinister persons refusing to consider it a disability).

jlg23• 4 years ago

I wonder if discrimination based on handedness is unlawful anywhere.

Most probably. But I think judges would agree that this is a "discrimination" not in the social or political sense but as a rather scientific method to determine whether a procedure is suitable/beneficial/at least not harmful.

If not, sign me up to sue all gynecologists because they refuse to treat my (a man) ovaries....

yellowapple4• 4 years ago

I mean, if you do have ovaries, and a gynecologist refused to treat them, then that seems like a bad thing. Probably a relevant concern for FtM trans folks.

green-eclipse• 4 years ago

"Moreover, the patient is left-handed. This makes things more complicated because the neural pathways of the brain are much more complicated."

This is fascinating. Why would this be?

pineal2• 4 years ago

Without further information regarding the exact location of the patient’s tumor, it is hard to comment in detail. However, one way handedness affects awake glioma resection is that while right handed people typically have their language dominance localize to the left hemisphere, left handed individuals are more likely to have right sided or even codominant language function. Assuming this was a right sided tumor, the surgeon probably meant that he also had to account for avoiding speech deficits in this left handed patient that he wouldn’t worry about in a right handed one.

aliljet• 4 years ago

Integration testing of the brain during surgery? I wonder if the apparatus for this kind of complex testing can be simulated. Seems incredibly powerful....

thomasahle• 4 years ago

Is this because playing sax is the only function he cared about preserving? Or did he perform other tasks too when they were operating in other parts of the brain?

dansimau• 4 years ago

From TFA:

"To play an instrument means that you can understand music, which is a high cognitive function. It means you can interact with the instrument, you can coordinate both hands, you can exercise memory, you can count — because music is mathematics — you can test vision because the patient has to see the instrument, and you can test the way the patient interacts with the rest of the team," he said.

I take that to mean that playing the instrument uses many brain functions and so they're able to monitor many things at once.

abhorrence• 4 years ago

The vision but seems plainly wrong to me, many (and I’d posit most) musicians who have been playing their instruments for years can play with their eyes closed. Definitely would test proprioception though!

Llamamoe• 4 years ago

What the heck. Why? What if he moved or panicked and disturbed the surgeon?

asah• 4 years ago

for brain surgeries, the head is immobilized.

jcadam2• 4 years ago

That would make playing any sort of wind instrument quite a bit more difficult.

danjc• 4 years ago

I think the procedure is do some surgery, stop, have the patient play the sax, repeat.

Similar to write some code, run the app, repeat.

peterkelly• 4 years ago

A similar thing was done with a violinist a couple of years ago:

https://www.smithsonianmag.com/smart-news/watch-musician-pla...

Related research study on the practice: https://pubmed.ncbi.nlm.nih.gov/32505870/

If I ever need brain surgery, I guess they'll probably have me try to respond to JIRA tickets and troubleshoot npm dependency conflicts during the operation.

marstall• 4 years ago

lol!

bombcar• 4 years ago

I’d be afraid that using JIRA would register as complete brain death.

ASalazarMX• 4 years ago

- Not a problem

- Works as designed

- It's a feature

- This is egregious! I'll get to fix it immediately

Doctors: Oh no, we cut too much!

zasdffaa• 4 years ago

WONTFIX - (skull closed)

q7xvh97o2pDhNrh2• 4 years ago

I've always wondered about this. Is there a doctor in the house who could clarify the value of having this kind of lagging indicator?

Presumably, the idea of having the musician playing is to give the doctor a heads-up in case they slice into a valuable area of the brain. But, by the time the music playing is affected, the slice would have already happened — so then, what's the point?

I agree it's a great way to harvest social media likes (which presumably helps pay the medical bills, so I suppose it's nothing to sneeze at). But it's tough to see how it'd meaningfully help a fine-grained surgery. That abstract on PubMed ^ seems to say much the same:

...playing music did not improve or modify surgery.

simon_acca• 4 years ago

They are not slicing while the guy is playing. Rather they stimulate electrically the area that they are about to slice to check if brain function is affected.

throwthere• 4 years ago

Skim through this from UCSF for more info-- https://braintumorcenter.ucsf.edu/treatment/surgery/brain-ma...

busyant• 4 years ago

If I ever need brain surgery, I guess they'll probably have me try to respond to JIRA tickets and troubleshoot npm dependency

for me they will ask me to play chess. and they will stop cutting when i start making good moves.

panzi• 4 years ago

Man dicks around on YouTube through 9 hour complex brain surgery to remove tumor.

smckk• 4 years ago

Man performs surgery through 9 hour complex brain surgery.

sebazzz2• 4 years ago

I wonder what the nerdy software developer equivalent is of this. I can't play an musical instrument. However, I'm plenty fine with: (1) Fusion 360, (2) .NET Web Development, (3) playing FPS/RPG/simulation/puzzle computer games.

jcadam2• 4 years ago

You should pick one up. Learning how to read music and play an instrument at the same time is good for the brain.

sebazzz2• 4 years ago

I tried, I really don't have a knack for it.

iancmceachern2• 4 years ago

It's an interview, you have to pass a software engineer interview

mikotodomo• 4 years ago

Makes sense, doing an intellectual activity while getting brain surgery probably helps them like when they tell you to move your muscles around when getting normal surgery.

Anunayj• 4 years ago

Makes a small change

npm run test

38/48 tests passed, 10 failed.

Ah schmutz, looks like we made a mistake

git revert

tomcam8• 4 years ago

I am ancient. When I was your age there was a very old joke that went some thing like “Dr., will I be able to play violin after the operation?“ The doctor says: “absolutely.“ And the patient says “great, because I don’t know how play violin at all“. I was sure other old-timers had use this joke before my latest operation, and I was going to overturn it by saying “good because I actually do play violin.“, knowing they were expecting the other punchline. Alas, this joke has completely expired. No one under 30 or so has heard it. I looked like a damn fool.

sgtnoodle• 4 years ago

This Simpsons episode isn't 30 years old yet, is it? https://youtu.be/JlmzUEQxOvA

sbierwagen• 4 years ago

It's 26 years old, so it'll be turning 30 soon.

StrictDabbler• 4 years ago

That joke was famous for about 70-80 years. I know Henny Youngman told it but I doubt it was his.

You were telling a joke that was old long before you were born and you grew up in a world where others might know it because we were all watching old shit on television.

That television was mostly written by men who were born between the wars.

There's a precise birthdate where a child's life would never force them to watch reruns of Gilligan's Island and it is nearly the same as the birthdate for never watching Night Court or The Maltese Falcon.

Reruns died sharply and took a bunch of the 20th century monoculture with them. It's very surprising.

KrishnaShripad• 4 years ago

Video of the man playing saxophone during his brain surgery: https://www.youtube.com/watch?v=EAuAWaLG2_s

slmjkdbtl• 4 years ago

I hope there was recordings of what he played

weitzj• 4 years ago

Really interesting. Back at university I got the chance to attend a surgery since our physics department donored a graphics card for the medical department running a DecAlpha with True64 which had a pixel error. And this machine was used for brain surgery. So better not to have a pixel error.

Most of the surgery 8 hours was done with 2 doctors and 2 medical physicists in front of the computer and simulate where to drill a hole in the head and where to pass a needle without touching a vessel.

After the coordinates were found the actual surgery 1 hour happened with the patient awake.

Also I was very impressed when the neurologist came in and hooked up with a Windows 2000 laptop to the brain pacemaker (against Parkinson’s) and tweaked the stimulation currents.

The patient had to count the weekdays aloud and started mumbling around the word “Thursday”. Afterwards the neurologist typed onto his laptop, pressed “enter” and the patient could talk again.

Man plays his saxophone through 9-hour complex brain surgery to remove tumor

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