Mayo Clinic official discusses awake brain surgery

contributor, doctor neha sharma and the chair of neuro- surgery at the mayo clinic — doctor bernard bendok. they are discussing awake brain surgery. dr. neha sharma looks into awake surgery at the mayo clinic dr. sharma: clinic dr. sharma: this is such a fascinating development. dr. bendock, can you please tell us what exactly is awake brain surgery. dr. bendok replies: well, first of all i’d like to say that even though we call it awake brain surgery, it’s actually asleep awake asleep, in reality. because we make sure to block all the nerves in the scalp that can eliminate pain. and the patient’s typically put to sleep for the incision and the exposure with sedation. and then during that delicate part of the procedure where we are trying to map the brain to give the best possible outcome to the patient, that integrates what we know about that patients humanity whether they are a piano player, or an opera singer, a talk show host, we want to make sure that we integrate that into our plan. and so we typically have a neurologist in the room sitting with the patient, examing the patient during that part of the operation. interestingly, that part of the operation doesn’t typically hurt because stimually the brain is not a painful thing to happen. so it gives us a lot of great information that allows us to tailor the operation to that patient’s needs. and it incorporates the most important elements of that patient’s life into the operation. dr. sharma asks: that is great. and who is an ideal candidate for the surgery and what are the indications? dr. bendock responds: you know anytime we are thinking about an operation that involves delicate tissue that has to be removed or stimulated that is near critical areas of the brain, that would be a good indication that at least think about this operation. obviously it takes a motivated patient. and the way we tackle that motivation is, you know, a patient’s first year that we are recommending the operation be done awake, the first reaction is obviously always fear, even if the patient is a doctor. but when you take that fear and you educate the patient by letting them know that you care about what’s most important to them and preserving that function, all of a sudden that fear becomes motivation. and that patient becomes an active participant in their care rather than a just a passive recipient of the care. and that makes all the difference. and so i had an opera singer once for example, who told me, if i wake up paralyzed it wouldn’t be the end of the world. but if i cannot sing opera, my life is over. so it became the whole focus of the operation, to not only treat her avm, but to actually map out her singing abilities relative to that avm and to factor that into the operation. so we actually had her sing during the operation and she was singing as soon as she woke up from the operation. which at that the end of the day was what she wanted and what we had to deliver. dr. sharma asks: right. and the recovery process; is it the same as a conventional procedure for the patients or is there anything different? dr. bendock answers: well you know dr. sharma that’s a great question, interestingly when people are not put under general anesthesia, the recovery can be faster. and for the right patient, if it’s indicated, it’s the right thing to do, the beautiful thing about being awake during this part of the procedure is that we have a neurological examine as soon as they wake up and can go often go home either later that day or the next morning. where sometimes, when people are put to sleep, the drugs that are need to put somebody to sleep can sometimes result in their recovery being a little bit slower. so when it’s the right thing to do, an added benefit can be a faster recovery. dr. sharma: it is such an intriguing concept. and i want to ask you, can you tell us if this concept will ever expand beyond the brain? dr. bendock answers: you know, interestingly, many areas of health care people, have been moving to regional anesthesia rather than putting a patient completely asleep. for example, in orthopedics. it has become much more common to do a regional block, to block the nerves to the leg, let’s say, so the patient has no pain. and we are seeing this is many other areas, even some areas of cardiac surgery, believe it or not. people are starting to understand and probe this area. so there are some advantages, there are some disadvantages but with modern pharmacology and the modern drugs, we can move away from general anesthesia in some cases, again not for everyone not for every operation, but for select operations, it could be the better way to go. dr. sharma: thank you so much for your time dr. bendock. dr. bendock: absolutely, my pleasure. dr. sharma: that was dr. bernard bendock with the mayo clinic with exciting development.