2023-12-22 23:00:46
Sergio remembers little about the surgery he underwent a few days ago at the Cremona hospital: the preparation, the moment of anesthesia, a bad taste in his mouth. The doctors calling him by name while he is “under the knife”, waking up, the right eye not opening properly. In the operating room he recognizes the background music that he has chosen and, upon indication from the doctors, begins to keep the rhythm, with fluid and precise gestures, beating on two small drums recovered for the occasion. Meanwhile, the surgeons tinker behind him, finalizing the maneuvers to remove a large tumor from the insula. “A very delicate area of the brain on which important functions such as language, movement and creativity depend. For this reason – explains Antonio Fioravanti, who directed the hospital’s Neurosurgery team in the 65th complex operation of ‘awake surgery ‘ – having the patient play during the operation was clinically decisive.”
The patient – 39 years old, cryogenic physicist, researcher in Barcelona – is fine. Sitting on the hospital bed, legs crossed, he can’t understand what has happened: “It’s shocking to think that someone has touched my brain, the place of thoughts, feelings and memory; a kind of sacred organ, well protected in his skull.” Sergio said he was “very happy to return home for Christmas and be with my family who have been of great comfort to me. I know that cycles of therapy await me”. But in the meantime he says: “I’m surprised that I was able to get out of bed immediately, I speak normally, my hands move as I want.”
Until a few years ago Sergio played the drums. “I would never have thought of performing in the operating room in such a difficult condition, I felt like I was living in a dream”, he smiles. When the surgeons asked him to stop, he asked again: “Can I play for 10 more minutes?”. The diagnosis of Glioma (low grade) arrived on November 10th, after some tests carried out in a hospital in Barcelona, following sudden epileptic seizures. From that moment there were two consultations in Spain (where Sergio has lived for 8 years) and one in Italy, then the telemedicine visit with the Neurosurgery of Cremona and the choice. “Facing an operation like this is scary, but I didn’t experience it as a violation of the body, on the contrary. It was like putting my life in good hands. The fear is there and it’s great, it marks you”, says Sergio, who adds: “I have decided to blindly trust doctors and science. I would tell a person in my situation not to be discouraged, if you don’t face the operation then don’t tell them about it.”
“Awake surgery, practiced at the Cremona hospital for 5 years – explains Fioravanti – is a very sophisticated method that allows you to dialogue and interact with the patient during the operation. This guarantees a sort of double control in real time compared to the “progress of the operation which, in this specific case, was very complex. Sergio, in fact, in addition to being a young man, is ambidextrous and bilingual: being able to preserve both functions (language and movement) was our objective”. To achieve it, in addition to the interaction between doctor and patient, “in the operating room we also used the ‘navigator’, a highly precise guide which, together with fluorescence (a technique that colors tumor cells) helped us to circumscribe the area to be removed and create the best conditions to keep his abilities intact”, continues the white coat.
Awake surgery is a very involved technique. “A symbiotic relationship is created with the patient, each time it’s a different emotion. While I was talking to Sergio and he was answering, moving his hands, playing, I was aware of the progress of the surgery, it’s difficult to explain what I felt in that moment,” says Fioravanti. Of course, points out Sara Subacchi, neuropsychologist, “not all patients are candidates for awake surgery, a certain psychological and cognitive attitude is needed, good control of anxiety, emotions and stress. In the days preceding entry into the operating room the patient is prepared through the simulation of what will happen: the posture to hold, the moment of awakening, the tests to which he will be subjected. There must be no surprises”.
In Sergio’s case, he continues, “the preparation also included the use of percussion, an element familiar to him, which helped him remain calm and concentrated. His performance during the operation was fundamental in evaluating his ability to move the hands, to keep the rhythm in a coordinated way, to measure strength and many other aspects”. Sergio, says the head of Neuroanesthesia Elena Grappa, “proved to be a lucid, very rational, calm person. In these cases, the patient is put to sleep with a particular anesthetic technique which contemplates the need to be able to awaken him, at the right moment, with the maximum tranquility. The waking phase is the most delicate, it requires continuous monitoring of parameters and time management”. Before the operation, neuroradiologists draw a map of the brain in colour, as Claudia Ambrosi, director of Neuroradiology, explains. Sergio was subjected to two specific tests: “We performed a verbal production test, both in Italian and English, mapping the main areas of language. The second test was of a motor type, involving the execution of fine movements of the fingers, to trace , in a similar way, the map of the motor area”, concludes the expert.
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