Awake surgery has been a hot spot of neurosurgical research and a growing site of interest for journalists and scholars. The idea is simple yet radical. The patient has a tumor that lies close to the “eloquent areas.” Removing this tumor puts at risk their cognitive abilities, in particular those related to speech. Instead of waiting for them to wake up in order to assess potential damage, which may then be irreversible, why not keep them wide awake during the process, and simulate with low-current electricity the effect of potential lesions on the brain? The result is a very atypical surgical situation with a speaking patient, a patient which is aware of what is happening in the room. This calls for a mastery of the atmosphere around the patient, an atmosphere that requires perfectly rounded-up teamwork to even out possible stressful situations. Here is a draft of one of the graphic ethnographic “series,” that I am presenting in the “Sketching Brains” participant exhibition at Charité in Berlin.
Credit MLC
That morning as I follow Katharina Faust to the OR, she tells me about the “very big tumour” she will have to expurgate from the patient’s brain. The patient is an artist. The OR is quiet, that particular patient seems quite sedated. Katharina bends over the patient, and with a very soft voice, greets her and asks her how she’s feeling today. Mehmet Tuncer, a junior resident who will be stay in contact with the patient during the whole operation, is already at her side. He has already built a relation of trust with the lady? The sounds are ushed and the movements are quiet.
Credit MLC
Three students are in the room this morning: the OR keeps it character of theater and it is very usual to have a small audience for the neurosurgeons at the University Hospital of Charité, which is the leading training center in Germany and in Europe. A few more signatures for Katharina, who seems to be signing papers all day, even a few away from a feat of surgical mastery.
Credit MLC
The skull of the patient is held into a metal clasp, between two dented spikes, as in any other neurosurgical intervention. What is usually a routine affair of a few seconds take longer when the patient is awake, as this is one of the least comfortable feature of the intervention: feeling one’s head stuck into a jaw of steel. A decent amount of local anesthetics makes it a bit easier. The instrument is shown to the patient to reduce her anxiety, with a few sympathetic words.
Credit MLC
A little electric trimmer buzzes in the hands of Katharina as she clears the space where she will incise the scalp. At the site where the outside world is about to smuggle in, a generous spraying of antiseptic solution is keeping the danger of a bacterial incursion at bay.
The head of the patient is also “registered” for the virtual representations of the screen to match with the actual body. A stereoscopic set of cameras is helping the system keep track of the scene, orienting itself of the bearing of the four balls assembled into a cross. On the three big screens of the OR, the scans show the bulky tumour in dark, dangerously close to the colorful lines hinting at the presence of language tracks pathways in the connective tissues of the white matter.
Credit MLC
When the trimming is done, Dr Faust covers the patient’s head with adhesive blue paper protections. Only the site of the craniotomy will be apparent from this side. On the opposite side of the bed, an assemblage of machines has taken over part of the vital functions of the body for the length of the operation.
Credit MLC
My tablet is running out of battery. The last image I can sketch is in the middle of the langage mapping: as Katharina is touching the brains with a pair of electrodes, triggering a temporary inactivation at a determined point, Mehmet is showing to the lady a set of images. Every time Mehmet says “anomie,” it means that the word, like “hand” or “cat,” came out wrong from the patient’s mouth. Katharina then duly puts a numbered piece of paper on the area she just probed, and registers it into the machine with a long pointer. Another round of images focuses on actions. This series of linguistic tasks, coming straight from neuroscientific experimental processes, makes it possible to assess if that specific part of the cortex is critical to the speech functions. The lady is getting tired, but the key information is in. The resection can start! It’s a impressive moment which I won’t be able to render today in the graphic form, as my iPad calls it a day. Next operation is two days, later. That’s exciting!