Best Doctors 2011: Dr. Andrew Sloan

A case I'll never forget: Using a virtual map of the brain to safely remove a massive tumor

Debi Grzybowski had a tumor on the left side of the brain that was causing massive, pounding headaches. Debi's first doctor thought it was too dangerous an area to operate.

She had a glioblastoma multiforme tumor, one of the most malignant tumors you can have. Debi wanted a second opinion, so my colleague asked if I would mind seeing her.

It turned out that Debi's tumor was causing pressure on areas of the brain that control language.

But while the tumor pushed on these areas, it did not encompass them, making me think that it might be feasible to remove the tumor without damaging these areas.

I met with Debi and told her we had two objectives with surgery: We wanted to remove as much tumor as possible, but we didn't want to risk her speech in any way.

This particular surgery was really risky. During an awake craniotomy, the patient is conscious for a critical portion of the procedure. We heavily sedate them in the beginning and perform a scalp incision, removing the top of the skull to expose the brain during part of the surgery. I've seen people panic and try to get off the table with their head open.

But Debi was very calm, she wasn't claustrophobic, and she understood what was going on. I thought she was a good candidate.

[Before the surgery] I told Debi I couldn't make any guarantees. I'd do my best, but if it ever became an issue and her language was jeopardized, I'd rather leave the tumor behind than lose the speech.

Before I started Debi's procedure, I looked at a virtual map of her brain. I have a wand that, when I point to any part of the brain, it tracks your position in three dimensions, just like a GPS tracks a car's position in the city.

The issue, though, is that sometimes the brain shifts and the map tells you you're in one place when you're actually in a different place. You have to always be double-checking that you're not cutting into a deeper structure. That's why experience is so important in these types of surgeries.

During the five-hour procedure, I kept checking on Debi's speech. We had her look at flashcards while a neurologist looked at her face.

Simultaneously, I stimulated her brain surface with a current while asking her to recite the alphabet. If she suddenly stopped, then I knew the area we touched regulates language, and we couldn't operate there without permanently damaging her language abilities.

But Debi did extremely well the whole time. I was able to take the entire solid part of the tumor out. We then put her back to sleep and closed her up.

There was still a worry.

Even though she was fine in surgery, we knew we were still really close to her language areas, and she might be a little worse the day after because of swelling.

The second day, she lost some of her speech function, which was a little scary. But by the fourth day she was speaking very well again, and by day five or six, she was pretty close to perfect.

That was 2 1/2 years ago. She's had 30 months of disease-free time with a diagnosis where the typical survival rate is 12 months. I'm still in touch with her, and she's doing extremely well.

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