Imagine having surgery to remove a tumor from your brain. Then imagine being awake during much of the procedure, so that surgeons can safely navigate around the area in your brain that controls speech.
San Diegan Krista McFadden just went through this surgery at UCSD's Thornton Hospital.
The morning of the surgery, Krista McFadden seemed pretty relaxed.
But she said looks can be deceiving.
"Obviously I'm very nervous," she said, "but at the same time, I feel very comfortable and confident with the physicians and the staff on hand."
That's a good thing, because surgeons were about to remove a tumor from her brain.
"What we're doing today," said chief neurosurgeon Bob Carter, "is performing a left craniotomy for a patient with a tumor in the left temporal lobe."
A number of doctors were involved in the surgery, including neuropsychologist Marc Norman.
He explained McFadden's tumor was close to the area of her brain that controls speech.
"And during the surgery today," Dr. Norman said, "we're going to be waking up the patient, and I will be speaking with her. And we want to make sure that we don't disrupt these functions."
Neurologist Jeff Gertsch would monitor her brain waves during the surgery, and look for signs of a seizure or other unusual activity.
After a quick goodbye to her husband Clay, McFadden was wheeled into the operating room.
The anesthesiologist put her to sleep while surgeons removed part of her skull and made an incision into her brain.
Once that was done, Dr. Carter took a break.
"So we're just waiting for Krista to wake up after the sedation that was given for the opening," he said, standing next to his patient. "This is the incision that you see here, and the surface of the temporal lobe and the frontal lobe. And we've got a little electrode that we've put in for monitoring procedures during the part where she comes awake."
As McFadden regained consciousness, Dr. Gertsch checked in with her.
"Krista, how are you doing?" he asked.
"I'm fine," she replied.
"Yeah, do you have any pain?"
"Not yet," she said.
In a moment, Dr. Carter began stimulating parts of McFadden's brain with a probe that had a small electrical charge. At the same time, Dr. Norman asked McFadden to count from one to ten.
Doctors were looking for any indications that her speech functions were disrupted by the probe. If so, Carter would know to steer clear of that area when cutting out her tumor.
Dr. Norman showed McFadden a series of picture cards and asked her to describe what she saw.
"This is a picture of shorts," McFadden responded.
"Good, that's right," said Carter. He showed her another one.
"This is a picture of a television," she said.
"Good, that's right," Carter replied.
After a few minutes, with no signs of any speech disruptions, Dr. Carter began to cut out McFadden's brain tumor.
After a while, Carter checked the depth of the resection against a three-dimensional image of the area projected on a computer monitor. Before he removed any more of the tumor, Carter wanted the team to check again to make sure the area of McFadden's brain that controls speech was protected.
Carter touched the probe on parts of McFadden's brain, while Norman showed her some more pictures.
"Can you speak for me?" he asked.
McFadden closed her eyes and groaned.
In a few seconds, she said "No, I couldn't speak."
Carter probed again. "Hey Krista," he asked, "can you count to ten for us?"
"One, two, three, four, five, ohhh……", she faltered again. Carter knew he was stimulating tissue that was disrupting language.
Carter then resumed cutting out the tumor, careful to stay away from the region he just discovered.
After some time, Carter stepped away from McFadden.
"We know that we've gotten a good resection of this lesion, anatomically," he said, "and we'll be able to stop our operation. And there will be a little uncertainty over the next several days as we get the final results back. But we don't this is any kind of malignant or cancerous lesions, which is good news for the patient."
As a surgical resident began to close up the incision and prepares to replace part of McFadden's skull, the anesthesiologist injected some medicine in her IV to put her back to sleep.
Dr. Gertsch turned to the patient.
"You did such a great job," he told her. "You're all done. Next time you wake up, you're probably gonna be in the recovery area, okay?"
But McFadden had already fallen asleep.
The surgeons wrapped things up. McFadden was wheeled into the recovery area. Dr. Carter walked out to talk to McFadden's husband.
"So everything went well," Carter told Clay out in the waiting area. "She talked to us, told us about the kids, told us about Halloween."
"She did really well," Carter continued. "And I think she's gonna be fine. I really do."
AFTERWORD: McFadden tumor was benign. She is resting at home.
