Saxophone Serenades Surgeons at University of Rochester Medical Center


>>This little sliver of
brain here is the area that we were trying to protect. We worked with you
on your breathing so that your brain wouldn’t come
all the way out of your head. [ Music ] Dan is a professional musician. He is also a music teacher. And he had a very unusual,
almost out-of-body experience. He started hearing things and seeing things
that weren’t there.>>Reality was here, and
the visions and the audio that I was experiencing
was also here. My mind was, like, fighting
over, okay, which is real? And it ended.>>He had an MRI
scan of his brain, which revealed a relatively
large tumor in an area that is involved with sophisticated hearing
and musical function.>>[laughs] You don’t say.>>He expressed how
concerned he was about losing his
musical ability.>>In Dan’s words,
“Music is my life.” There’s been an explosion
of technology that allows us to study the human
brain noninvasively. Functional MRI, or
magnetic resonance imaging, is one of the main technologies
that’s used in this regard. This allows us to create
maps of brain function.>>We could map mathematical
skill, the ability of a patient to use tools, to name
objects, to read. All of these functions
were available to us to map prior to surgery.>>Some patients then have
what’s called an awake craniotomy or an awake mapping
procedure during the surgery, during which time critical
functions can be mapped in real time by the surgeon
who is stimulating the brain with a bipolar electrode while
the patient is performing tasks. We knew that Dr.
Pilcher was planning to do an awake mapping session
with Dan, so we devised a series of tests that could be done
during functional MRI but also with an eye toward an
eventual awake mapping session in the operating room. My lab doesn’t have any
particular expertise in mapping music, so we called
our colleague, Dr. Betsy Marvin, at the Eastman School of Music.>>I’m trained as
a music theorist. My research area, though,
is music cognition. We talked about, what
is it that helps us to remember music
and to process it?>>In consultation
with Dr. Marvin, we came up with this test in which the patient
would hear a piano melody and would then have to
hum the piano melody back.>>My job was to
listen to him humming and to say whether it
was right or wrong.>>We interleaved
repetition of spoken sentences with repetition of
piano melodies.>>You’re going to hear
either a melody or a sentence, and then you’re going to
repeat it back out loud.>>We’ve spent many
days with him prior to surgery getting functional
MRI scans of his brain. We could then construct a
map, millimeter by millimeter, with great accuracy of
where music was located in relationship to this tumor.>>And the most assured way
in the operating room to know that his music abilities
were intact would be to actually have him
play his instrument. During your surgery,
you’re going to be laying down on your left side.>>That’s never how you’d play a
saxophone, so we really had to be creative in, how
is this going to work? I had far less movement,
far less freedom with the fingers on both hands. It was such an awkward
angle, and it worked.>>And he brought it in to
play for this team of nurses, and doctors, and
experimenters, and me. You could see the alarm
on the nurse’s face. She said, “If you play this
piece, which has some long, sustained notes in it,
the pressure of the wind and the performance on the saxophone will
make your brain protrude.>>So Dan and I worked
to modify the piece.>>Can you make that
first note shorter? [ Humming ] [ Music ]>>Kind of like that?>>Yeah, I think that sounds–>>Okay.
>>Great.>>The scene in the operating
room is pretty incredible because here you have a
young man with a tumor in the right side of his brain
lying on the operating table with his brain exposed,
completely awake. We have very fancy brain
lab stereotactic equipment. And once we get to the tumor,
we can then map the portions of the brain that
are responsible for his musical abilities,
and then we can avoid damage to those parts of the
brain while we’re taking out the tumor.>>Dan heard similar
piano melodies that he heard during
functional MRI scanning. [ Music ] [ Humming ] Dr. Marvin was in the operating
room scoring the patient’s performance in real time.>>We were continuously
testing him to see if anything we had done
impacted his musical abilities. I would stimulate
a region of brain that we felt was
responsible for music–>>Right.>>To try to interfere with
the ability of your brain to hear the note and to
hum a note correctly.>>You touch here,
melodies are fine. You touch here, melodies
are completely disrupted.>>He was unable to repeat these
piano melodies, but if he had to repeat a spoken
sentence, he had no trouble. [ Music ] [ Laughs ]>>No.>>And then, we got to the final
part of the tumor resection, which we knew was immediately
adjacent to the area which was responsible
for his musical talent. We felt very confident and removed the final
portion of this tumor. And after taking a deep
sigh of relief, we asked him to take out his saxophone.>>So we handed it to Dan. [ Background Conversations ] [ Music ] And he played it
really flawlessly. It was beautiful. [ Applause ]>>We have brought the
cognitive science laboratory into the operating room. Every patient where we
think there’s an opportunity to improve the outcome for that
patient, we asked Dr. Mahon to take a look at that patient. Every time we do an operation,
we have an opportunity to learn something
more about the brain. And that information makes
the operations we will do in the future all
the more successful.>>I went back to work just
over a month after the surgery.>>We are a year out
from his surgery. He’s teaching. He’s playing his instrument. He feels that his musical
talents are at least as good as they were prior to surgery. And he does not have
seizures anymore. His tumor is gone. And he has his entire
life ahead of him. [ Music ]

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