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.
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.
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.
Isn’t it incredible that for how advanced modern medicine is, we’ve essentially found something so complicated that the best we can do is poke around and see what happens?
It's a bit more sophisticated than that; she knows almost precisely what is going to happen, but the exact boundaries of the fluent brain that she's looking for are not clearly marked, and brain moves around a little; these are not solid-state circuits, so without this check you would have to err on the side of caution, which is contrary to the goal of removing as much tumor as possible. Probing ahead of where they're going to resect is a simple and effective solution.
> 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
Dang are there really that many totally bored people in the world? I gave up before the 2nd ad finished...how long do you have to watch for it to count as a "view" I wonder?
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.
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.
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?
Propofol would be for heavy sedation and would require an anesthesiologist or nurse anesthetist to be present. My insurance didn't cover that. I checked, and what I got was Versed (midazolam) + fentanyl.
At least in my prior experience with benzodiazepines like Xanax or lorazepam, they didn't cause any amnesia. I've never had fentanyl or any synthetic opioid besides during this procedure, so maybe that was what caused the amnesia. Or maybe there was no amnesia, and I was just so stoned from the combination that I was asleep and didn't really experience much except when some pain woke me up... I guess that's what I'm wondering.
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?
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.
I just googled it because I've never heard of it before... it's pretty crazy.
Apparently, the wrestlers cut themselves on their scalp / forehead some time into a match to make the match look more intense, with the blood from their head mixing with sweat and dripping down...
A 17 year old kid was even hospitalized due to blood loss from it.
So when pro wrestlers bleed there are two ways, blading and hard way. Hard way is exactly as it sounds, someone got hit so hard they got busted open. The second and what the OP is referring to is blading, you get a thin razor blade and nick your scalp-forehead area and you start bleeding. It isn't as extreme as they made it sound.
Had that happen to me accidentally. I felt just fine(tm) but everyone was looking at me like i was dying. In hindsight i probably looked like Carrie from Stephen King's novel, could feel the blood on my face.
Bleeding stopped in a minute or two just by holding a towel on the scratched part.
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.
> 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.
I imagine it might be similar to having a cavity filled.
Strange, I imagine, because you'd have the vibrations and sounds as you describe of the actual cutting, but also the feeling (whatever that's like) of reducing intracranial pressure.
If the drill is medical grade and extremely fast, you might not feel any vibrations at all, almost like a laser. Should feel like a scrape more than anything.
I don't know what you (personally) imagine when you say 'medical grade', but surgery (other than robots and keyhole I suppose) is pretty brutal and mechanical. A 'medical-grade drill' is basically whatever's been approved for medical use, not (necessarily, though I don't doubt they exist) something special that isn't also sold for drilling masonry.
When I’ve had surgery that was the joke the doctor told. It’s just a $10,000 version of a tool you’d pick up at Home Depot.
Obviously there are some things that would be different. For example a big issue is you’d want to use non-toxic lubricant on all the parts. Not sure what non-toxic means but I’m sure there is something (vegetable oil? Silicone?)
You’d also want to make sure it won’t fling off tiny metal or plastic shards from the tool. Don’t want that to get into the body. You’d probably have to seal up any ventilation openings in such a way that crap couldn’t escape.
I’m sure mechanically you’d want it to be as tight of tolerance as you could get away with—you probably don’t want a lot of slop when cutting open some dudes skull. Vibration and such probably play into that tolerance bit…
Of course it could just literally be a rebranded Ryobi or something for all I know. But I’m pretty sure it isn’t. Too many additional requirements means it is probably something slightly fancier.
The ones used in the operating room are different, but for putting traction pins in broken legs (in mid-shaft femur fractures, they will put a pin through the lower part of the femur and hang weights off the end of the bed to straighten the fracture out until the patient can go to surgery), they just use a regular cordless drill since the procedure is not fully sterile.
100%, orthopedics are intense. They use pneumatic drills and saws so the auto shop analogy isn't far off. In the med device industry ortho docs are often described as mechanics and they often have a lot of physical issues themselves ad they age because it's such hard physical work.
Not long ago I designed a set of bone taps and drills along with a bunch of related instruments and they were designed and made not much differently than high end tools for metal or woodworking.
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 ?
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?
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.
With our brain surgery robot the brain surgeon can definitely perform brain surgery on himself. Or invite a fellow brain surgeon over the phone, well a tablet might work better. Or better VR 3d glasses.
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.
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.
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.
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.
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.
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.
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.
> “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).
> 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....
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.
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.
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?
> "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.
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!
Well, those musicians likely have highly developed internal visualization skills, but of course I'm not keen on how transferable that is to real vision.
It's more about muscle memory, touch, and hearing than it is about trying to visualize the instrument in your head.
Source: I'm an amateur musician. Judging that even I can play the instruments I know without needing to necessarily see the instrument or the notes to play (actually or imaginatively), I'd imagine actual professionals shouldn't have a problem.
I'm a trained musician, and what I'm referring to is often called mental play[0]. Einstein referred to it as visual thinking. Many successful experts across many domains will tell you that visualization skills are a key factor in their success.
Any practice routine worth its salt includes visualization exercises. For example, players are encouraged to use mirrors while they learn in order to strengthen their visual memory, and eventually players are taught to imagine the instrument in their head, to imagine practicing. This has shown to be a viable method for making real improvements while not even holding your instrument, including boosting your muscle memory as your body learns to make stronger associations.
I obviously cannot speak for everyone, but when I play music from memory (and yes, often with my eyes closed) there isn't any visualization at all. It's all a combination of sound and muscle memory. Indeed, for plenty of music I would never have seen sheet music to be visualizing...
Visualization is a skill you must develop, a muscle in its own right you have to mentally flex. You don't visualize because you were not taught to, didn't think of it on your own, and thus don't practice it. It's not required for success, but it's a great tool for learning and improving.
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.
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.
Integration testing of the brain during surgery? I wonder if the apparatus for this kind of complex testing can be simulated. Seems incredibly powerful....
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.