Fabio, a music teacher was working on a school project when he suddenly began to “see and hear things that I knew were not real.” The hallucinations came with dizziness and nausea which prompted a visit to a nearby hospital. Following a series of investigations including a Brain CT, he was told he had brain cancer. Fortunately, this was a slow growing tumour that had been present since childhood. However, removal of the tumour could affect Fabio’s musical abilities and jeopardize his career. So, his doctors decided to offer surgical intervention that would preserve his musical abilities.
Preserving specific skills of the patient while removing brain tissue is very challenging. Why? Within the operating room, it may be difficult to tell if the removal of certain tissues may have significant impact on basic functions. Generally, doctors have a fair knowledge of the functions sub-served by different parts of the brain. However, individual variations may occur from time to time. Hence, the full impact of a surgical procedure may not be evident until several weeks to months after surgery.
In the case published in the academic journal Current biology, the surgeons were able to overcome this problem by asking the patient to play saxophone in the operating room!
Credit: Image courtesy of University of Rochester Medical Center
Why did the surgeons ask the patient to play saxophone?
This was to assess the immediate impact of the surgery on the patient’s musical skills. In a statement by Dr Pilcher, the Ernest and Thelma Del Monte Distinguished Professor of Neuromedicine and Chair of Department of Neurosurgery,
Removing a tumor from the brain can have significant consequences depending upon its location. Both the tumor itself and the operation to remove it can damage tissue and disrupt communication between different parts of the brain. It is, therefore, critical to understand as much as you can about each individual patient before you bring them into the operating room so we can perform the procedure without causing damage to parts of the brain that are important to that person’s life and function.
In order to achieve this difficult task, the neurosurgeon, Dr Pilcher, collaborated with an expert in brain and cognitive sciences, Dr Mahlon and a professor of music, Dr Elizabeth Marvin.
Everybody’s brain is organized in more or less the same way. But the particular location at a fine grain level of a given function can vary sometimes up to a couple centimeters from one person to another. And so it’s really important to carry out this kind of detailed investigation for each individual patient
Together, they developed a series of musical tests that Fabio could perform while the researchers were scanning his brain and came up with asking Fabio to play the saxophone while lying on the operating table with the brain exposed. And that is what they did after the tumour had been removed. Was he able to play the musical instrument well?
“It made you want to cry. “He played it flawlessly and when he finished the entire operating room erupted in applause.”
“The whole episode struck me as quite staggering that a music theorist could stand in an operating room and somehow be a consultant to brain surgeons,” said Marvin. “In fact, it turned out to be one of the most amazing days of my life because if felt like all of my training was suddenly changing someone’s life and allowing this young man to retain his musical abilities.”
Clearly, the operation was successful, highlighting the potential impact of effective collaboration.
“I was 25 at the time and I don’t think there is any age when it is OK to hear that,” recalled Fabbio. “I had never had any health problems before and the first thing my mind went to was cancer.”
Happily, with effective collaboration and remarkable approach to surgery, he returned to work a few months later and has continued to pursue his love for music.