Brain Tumor Res Treat.  2023 Apr;11(2):145-152. 10.14791/btrt.2023.0002.

Awake Craniotomy and Intraoperative Musical Performance for Brain Tumor Surgery: Case Report and Literature Review

Affiliations
  • 1Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

Abstract

Music experience and creation is a complex phenomenon that involves multiple brain structures. Music mapping during awake brain surgery, in addition to standard speech and motor mapping, remains a controversial topic. Music function can be impaired selectively, despite overlap with other neural networks commonly tested during direct cortical stimulation. We describe the case of a 34-year-old male patient presenting with a glioma located within eloquent cortex, who is also a professional musician and actor. We performed an awake craniotomy (AC) that mapped the standard motor and speech areas, while the patient played guitar intraoperatively and sang. Outcomes were remarkable with preservation of function and noted improvements in his musical abilities in outpatient follow-up. In addition, we performed a review of the literature in which awake craniotomies were performed for the removal of brain tumors in patients with some background in music (e.g., score reading, humming/singing). To date, only 4 patients have played a musical instrument intraoperatively during an AC for brain tumor resection. Using awake cortical mapping techniques and paradigms for preserving speech function during an intraoperative musical performance with singing is feasible and can yield a great result for patients. The use of standard brain mapping over music processing mapping did not yield a negative outcome. More experience is needed to understand and standardize this procedure as the field of brain mapping continues to grow for tumor resections.

Keyword

Aphasia; Brain neoplasms; Brain mapping; Craniotomy; Glioma; Music

Figure

  • Fig. 1 Representative T2/fluid-attenuated inversion recovery MRI on admission (axial, coronal, and sagittal, from left to right, respectively). These images show a hyperintense non-enhancing mass in the left temporal lobe, measuring 4.1×3.6×3.4 cm with extension to posterior superior temporal gyrus (arrow).

  • Fig. 2 Functional magnetic resonance imaging (fMRI). A: Axial fMRI shows activation of language areas during word-generation/sentence completion tasks in bilateral cerebral hemispheres in temporal lobes (left greater than right; arrowhead). B: Axial fMRI shows blood-oxygen-level dependent activation can be seen superior to the mass during the movement of the tongue in the precentral gyrus bilaterally (arrowhead).

  • Fig. 3 Diffusion tensor imaging demonstrates tracts from the arcuate fasciculus and inferior longitudinal fasciculus partially displaced from the mass effect of the tumor. This also demonstrates how close the fibers are associated with the lesion, which would benefit from an awake craniotomy.

  • Fig. 4 Resection of brain tumor with speech mapping. A: Intraoperative image of the patient playing his guitar during the awake craniotomy. B and C: Postoperative axial (B) and sagittal (C) fluid-attenuated inversion recovery MRI showing resection cavity with a small residual portion of blood products and granulation tissue at the base (arrow).


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