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Wide Awake and Under the Knife

Neurosurgeons Keep Patient Awake During Brain Surgery to Ensure Most Complete Tumor Removal, Minimize Brain Injury

March 1, 2011

Neurosurgeons removed a brain tumor from a patient and kept her awake during surgery to ensure removal was successful. This particular tumor was near the area of the brain responsible for speech, a tricky removal process. They used a probe to test different areas of the brain while the patient was awake on the table, ensuring that the patient’s speech was left intact. The technique allowed for removal of more of the tumor, which leads to better survival rates.

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WHAT CAUSES BRAIN TUMORS: Brain tumors, like most other cancerous growths, are the result of uncontrolled cell divisions caused by mutations in key genes within those cells -- in this case, the neurons in the brain. Normal neurons don't divide because their genetic coding tells them not to do so. Cancerous neurons are mutated so that the growth switch is turned back on. They begin to divide and multiple uncontrollably, forming a tumor.

HOW THE HUMAN BRAIN PROCESSES LANGUAGE: What parts of the brain control language? There are two primary sections of the brain that relate to language and communication, and if either section becomes damaged, the person will be unable to speak properly. The left frontal cortex of the brain is known as "Broca's Area," after a 19th century physician named Paul Broca. The second section is called "Wernicke's Area," after Broca's contemporary, Karl Wernicke. It is located further back and lower in the brain than Broca's Area, at the tail end of the temporal lobe. These two sections are connected by bundles of nerve fibers. When these connections are damaged, the person can understand language but their speech does not make sense and they cannot repeat words. In most people, both Broca's area and Wernicke's area are found only in the left side of the brain. Scientists have studied how electrical stimulation of these areas of the brain can block language. They have also injected fast-acting anesthetics into the right or left carotid artery. The right artery supplies the right side of the brain, while the left artery supplies the left side. Injecting an anesthetic into either will put that side of the brain to sleep. They found that when the left hemisphere of the brain was asleep, patients were unable to speak when asked questions. But they would be able to answer questions if the right side of the brain was asleep. But even though the left side of the brain is dominant when it comes to language, imaging studies of blood flow in the brain have shown that people with damage on the right side have trouble communicating the emotions involved with language. This disorder is called "aprosodia."

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To Go Inside This Science: 

Bob Carter, MD
Neurosurgeon
UCSD Medical Center
bobcarter@ucsd.edu


© 2011 American Institute of Physics