NewsJanuary 22, 2024 1:06 AM ET14,271 views

Florida man plays Deftones and System of a Down during brain surgery

Christian Nolen Guitar Surgery

During his brain surgery at the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Florida man Christian Nolen played the guitar as the surgical team removed a tumor from his right frontal lobe. 

During the surgery, Nolen performed various songs, including those by Deftones and System of a Down, as the surgeons carefully removed the tumor. 

The procedure was conducted while Nolen was awake to continuously monitor his brain functions and protect critical areas of the brain.

Nolen told WSVN Miami:

I'd only really heard of procedures of that nature being done in shows and movies. I felt like it was such a unique experience that I couldn't pass up — especially with my motor skills being on the line.

The risk of being sedated for the entire procedure outweighed any fear or anxieties around the procedure itself.

The tumor's location near critical brain areas necessitated an awake surgery to make sure vital functions are not impacted. The idea was to have Nolen play the guitar during the operation, thereby giving doctors real-time feedback on his motor skills. The approach allowed the surgical team, led by Dr. Ricardo Komotar, to precisely navigate around essential brain regions.

 Komotar explained:

When a tumor is involving or near a critical part of the brain — something that controls the ability to speak or understand language or move — we want to do the surgery awake to continually monitor the patient, so you know if you start to violate normal brain functions. 

After experiencing issues with his left hand that affected his guitar playing, Christian Nolen was ultimately diagnosed with a brain tumor. The surgery was booked 10 days later to confirm the diagnosis, identify the tumor type, and remove as much of it as possible. 

While initially under general anesthesia, Nolen was awakened for a critical portion of the two-hour surgery and, after being oriented, was asked to play the guitar. 

Nolen recalled:

Upon awakening, it was quite overwhelming to see everything around me and to fight the natural reaction to sit up.

A member of the care team calmed Nolen to stop him from sitting up. It took him a second to remember what was happening.

He said:

I just had to breathe and stay calm. 

As the surgeons removed the tumor, they continuously monitored Nolen's hand function while he played the guitar.

Doctor Komotar said:

As we were finishing the case at the very back of the tumor, we noticed that his hand function started to decline. The tumor was touching and interfacing with the part of the brain that controls hand movement. Fortunately, we were able to remove the entire tumor and not injure his hand.

Nolen said during surgery:

This is wild!

Komotar explained that Nolen's reaction is common:

Most patients are intrigued by the process. We tell them that they're going to be able to speak and move their hands or limbs so we can constantly examine them.

The doctor also noted the advantages of using awake anesthesia instead of deep general anesthesia during procedures:

Surgery with continuous neurological exam leads to better functional outcomes and fewer neurological deficits. 

He also said it's good for recovery and discharging a patient from the hospital:

The less anesthesia you use during your procedure, the better the patient wakes up. 

The faster they wake up, the sooner they are up and walking around, and the sooner they go home.

And inherently, the longer you're in the hospital, the more complications you have.

During a craniotomy while awake, patients can partake in any activity that don't elevate pressure in the head. Komotar mentioned that some patients even sing during brain surgery, enabling the surgeon to assess their language capabilities as tumors are removed from language-associated areas. 

Komotar does acknowledge that awake cranial surgery carries certain risks:

Seizures can definitely be worsened by doing awake surgery. If someone has a history of seizures, we try to avoid electric brain stimulation, which is part of the technique.

Komotar said that the concern with removal, while the patient is awake, is that approximately 5% to 10% of patients do not tolerate being awake during the procedure:

Even with world-class anesthesia, they might wake up either too startled or too in pain to be examined. They might be confused, agitated or unable to follow commands.

In that case, the team brings the patient to a sedated state and goes with a more cautious approach to removing the tumor. 

Komotar explained:

We only take out what we know is definitely safe, and we leave anything that's questionable.

Ultimately, the tumor was removed and the surgery went smoothly.

The doctor said:

Christian did terrific. He went home the day after surgery. He says his quality of life is better than it's ever been, so I think his recovery has been remarkable.

Following the surgery, Nolen's recovery has been very good. The first couple of weeks were tough due to post-surgery restrictions, but he was back to his hobbies of working out and playing guitar quickly. 

Nolen said:

The days were really dragging,. However, with a strong support system, I've been able to focus on the positives.

At this point, he is waiting on the final pathology results and might have to undergo some radiation and chemotherapy as a precaution.

The effectiveness of the surgery was said to be the result of a solid team.

Nolen said:

The team at Sylvester Comprehensive Cancer Center in Miami has been very informative and has not left much to the imagination in the best way possible. They have also provided me with quite a few programs for emotional support.

Komotar added:

A case like this spotlights the value of multidisciplinary care.

It's not possible to remove a tumor like this and get the patient home so quickly and in such good health without an entire comprehensive team — neuro anesthesiologists, great intensive care specialists, nurses, techs, great oncologists — all working together.

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