“Awake brain surgery” is exactly what it sounds like – the patient is awake and responsive while neurosurgeons probe, shock and cut into his or her brain tissue. In procedures such as these, the patient is numbed physically, but must remain cognizant in order to answer various questions so that the medical team can identify and “map out” which specific part of the brain is responsible for answering each type of question. With the skull opened and brain exposed in a sterile environment, doctors then probe different sections of the brain with a small electrical impulse to stimulate or hinder various sections as the team quizzes the patient.
Brain Mapping Questions
During this type of procedure, the patient may be asked, for example, to describe the relative sizes of various everyday items presented on a computer screen. When the patient suddenly finds it impossible to tell the medical team whether a horse is bigger than a mouse, the surgeons know they’re stimulating the specific part of the brain responsible for the basic function of understanding comparative size.
Modern surgeons have an impressive understanding of where different functions are carried out in the human brain, but normal variations between individuals, and especially in individuals suffering from brain lesions, make custom mapping a much safer option. Ani, a multilingual woman in Spain, recently underwent one such procedure to remove a brain lesion while the surgical team tested her linguistic skills, all in an effort to save her life – and her five languages.
Ani’s Case
Ani speaks five different languages (Armenian, Russian, Spanish, English, and French) and her extraordinary linguistic skills are crucial to her job, which she prefers not to discuss in detail.
Unfortunately, one day at work in 2018, these skills began to fail her. She first began to jumble her languages, then staggered and collapsed to the ground.
Medical exams revealed that Ani was suffering from a cavernoma in her brain, a potentially fatal cluster of malformed blood vessels. This type of issue causes bleeding that can permanently compromise a patient’s motor skills, language skills, and even hearing and vision, not to mention the potential for a fatal hemorrhage or seizure.
Ani’s Procedure
There was no question that the cavernoma needed to be removed, but Ani’s particular skill set meant that the procedure would require extensive preparation and a unique approach in order to preserve her valuable language capabilities. The lead neurosurgeon, Dr. Gloria Villalba, and her team at Barcelona’s Hospital del Mar designed a special battery of questions in Ani’s five different languages, which included basic tasks like counting to ten, naming common items displayed on a computer screen, and answering vocabulary questions. As the medical team quizzed her, Dr. Villalba would physically map Ani’s brain, placing tiny national flags between the folds of her brain tissue to indicate where Armenian was processed, where English was processed, etc.
On the day of the procedure, Ani was physically anesthetized before Dr. Villalba opened her skull and began the painstaking brain mapping process. The medical team began asking Ani the various language questions, with everything repeated in each of the five languages. While one part of her brain was being stimulated, she found that she could not recall a particular word in Spanish. She told the surgical team, “I know the word, but it doesn’t come out.” The doctors knew they had stimulated a crucial area for Spanish, and placed a tiny flag of Spain there to know to avoid it at all costs when removing the cavernoma.
In addition to the obvious linguistic implications for future patients, Ani had also agreed to participate in a form of research regarding people’s basic social cognition functions. While the medical team stimulated parts of her brain’s left hemisphere, she was asked to analyze pictures of common facial expressions that depicted feelings like happy, sad, or scared. Ani’s results will help contribute to researchers’ growing understanding of how and where the brain processes emotions and basic social cues.
The Result
Ani’s five languages actually made the procedure more difficult, as larger areas of her brain than normal were used for linguistic tasks. This gave the doctors a tighter tunnel through which to extract the lesion. Nevertheless, after six exhausting hours, Dr. Villalba and her team were able to remove the cavernoma.
The procedure was deemed a success, but Ani and her medical team know that recovery will be a long and arduous process. Physically, doctors will monitor her carefully for signs of infection and internal bleeding. Frequent MRIs are required to ensure that the cavernoma has not returned.
There are also challenges linguistically. She has maintained her five languages, though at the moment, they do not come as easily as they did before. She says, “Maybe I don’t speak as fluently as before, but it’s a matter of time. In a month or two, I think I’ll recover everything.”
Note: This article is based on the original Spanish-language piece published here.
