Brain Surgery: Surgeons make patients smile during awake surgery

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A good mood created by brain stimulation could calm patients during open brain surgery.

At least that's what a study in the Journal of Clinical Investigation suggests.

Medical researchers at the University of Emory in Atlanta, Georgia, USA found that stimulating a specific region in the brain triggers immediate laughter in the patient, followed by a feeling of calm and happiness.

The scientists now hope to be able to use this method to calm patients who have to be awake during brain surgery.

However, a German expert is skeptical as to whether the approach will prevail.

There are brain surgeries that require the patient to be conscious, such as removing a brain tumor that is very close to the center of vision or speech.

If the patient is awake, the relevant functions can be continuously queried and monitored during the operation using eye tests and voice tasks.

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However, such interventions often cause particular stress: "Even well-prepared patients can panic during an awake operation, which can be dangerous," says neurosurgeon Kelly Bijanki, lead author of the study, according to a press release.

The scientists report on a 23-year-old epilepsy patient who suffered from anxiety and depressive phases and had her seizures checked in the university clinic.

For this control, electrodes are placed in the brain in an initial procedure.

They should show which areas of the brain trigger an epileptic seizure.

During this monitoring, the doctors stimulated the woman's belt winding (cingulate gyrus) with electrical impulses.

The belt winding is part of the limbic system.

This functional unit of the brain is central to the processing of emotions.

When the neurosurgeons irritated a certain part, the patient showed a happy, relaxed demeanor.

One video shows that the woman is unable to frown or smile - even when the medics tell her to remember a sad situation.

She explains with a giggle: "That just feels good."

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The observed effect was then used to calm the patient during an operation two days later.

During such operations, the patient is first given an anesthetic so that he or she does not notice the skull opening.

After waking up, the woman initially panicked: “When we turned on her cingulum stimulation, she immediately reported that she felt happy and relaxed.

She told jokes about her family and was able to tolerate the waking procedure successfully, ”explains Bijanki.

The patient was close to tears

The specialist article also reports that the stimulation was unintentionally interrupted during the procedure: The patient then became nervous and anxious and was close to tears.

After restarting the stimulation, her anxiety quickly subsided and shortly afterwards her happiness returned.

This reaction was also confirmed by experiments with two other epilepsy patients.

For Walter Stummer, Director of the Clinic for Neurosurgery at the University Hospital in Münster and a member of the board of the German Society for Neurosurgery (DGNC), the findings are interesting.

"However, I am not sure whether the effort justifies the benefit." A second operation is necessary in addition to the actual procedure to place the electrode.

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The patient's head is clamped in a frame that specifies a coordinate system.

Then the right place for the electrode has to be found.

“Overall, the risks of such an intervention are low.

However, it requires specialist knowledge and a large, interdisciplinary team from neurosurgery, neurology and neurophysiology, ”explains Stummer, who was not involved in the study.

With less effort, stimulating the belt curl would actually be a helpful additional measure.

On the one hand, it could calm particularly anxious patients.

On the other hand, the sometimes very long awake operations, during which the patients have to continuously solve tasks, would probably be more bearable for them.

Overall, however, neurosurgery now has very good drugs and treatment methods to deal with anxious patients.

Stummer therefore sums up: "In view of the sophisticated methods that we already have, I am skeptical whether this will prevail."

This article was first published in February 2019.