“Innovative brain tumor removal interventions with awake and cooperative patients” were performed by the Neurosurgery Department of the University Hospital of Siena (Aous), which describes “2 very particular cases. Both patients were not native Italian speakers and the evaluation of the language area was the leitmotif of the interventions”. The first case concerns a young woman with a neoplasm in the left frontal area, near the expressive language and motor area, reports the Aous; the second a young man with a neoplasm in the left temporal lobe, near the language comprehension area.
“To remove the lesions in the movement and speech areas and preserve their higher cognitive functions, it was necessary to talk to the patients throughout the brain surgery – explains Francesca Tarantino, director of Neurosurgical Anesthesia and Resuscitation and interim director of Neurosurgery, who coordinated the multidisciplinary operating team – To this end, it was essential to modulate the anesthesia plan in order to guarantee, after an initial phase of deeper sedation, a subsequent phase of mild analgesia and finally a new phase of deepening the sedation: all to safeguard the ability of the awake patient to collaborate and respond to stimuli, free of pain and breathing spontaneously for the entire duration of the surgery. Both patients spoke good Italian as a second language and were helped by the linguistic mediators who were present in the operating room, in both cases, to communicate in the two different languages with the patients. The mediators, Noemi Muho and Jemmali Ghada, gave an important contribution because during the intervention it was essential to evaluate and protect all the linguistic skills of the patients, always under continuous monitoring of the vital parameters by the anesthesiology team”.
“During the surgical procedure – adds Salvatore Chibbaro, an expert in this type of neurosurgery and the first operator of the interventions – to monitor the functional integrity of the brain areas undergoing surgery, patients were asked to both describe images they saw and read texts in their native language, always with the help of linguistic mediators. To protect even the deepest motor areas, cranial electrical stimuli were used with direct and continuous recording (real time) of responses from the limbs, using an innovative method developed by the neurosurgeon and neurophysiologist of the staff, Alessandro Zalaffi. Thanks to these advanced techniques, which also include the use of the very modern exoscope with filters for fluorescent substances, it was possible to remove more than 90% of both tumors. The extensive removal, without generating permanent brain damage, preserving all higher functions, is the final goal to be achieved in these patients. To this end, teamwork and a prepared, motivated and cohesive multidisciplinary team are essential. Given the particularity of the cases, in the days following the operations, an in-depth meeting was held in Siena with colleagues from the Careggi University Hospital, experts in this type of operation and also for possible future collaborations, with appreciation for the Siena technique which consists of operating on patients while they are awake from the beginning and for the entire duration of the procedure, which represents a notable innovation and advancement in this type of surgery”.
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