Playing Guitar During Brain Tumor Surgery?

Sylvester’s neurosurgical team used Christian Nolen’s guitar-playing skills to test and protect his dexterity while removing as much tumor as possible.

Christian Nolen usually plays guitar on stage. But in December of 2023, the professional guitarist played songs from the alt-metal band Deftones while a neurosurgical team at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine worked to remove a tumor from his brain.

Doctors put Nolen to sleep at the beginning of the open craniotomy. Then, he was awakened during a delicate part of the two-hour procedure – called an ‘awake’ craniotomy – to play the guitar. This helped doctors evaluate and protect his manual dexterity while being as aggressive as possible in removing the tumor.

Ricardo Komotar, M.D., FAANS, FACS, the Sylvester brain and tumor neurosurgeon leading the team, says Nolen had a tumor called a glioma in the right frontal lobe of his brain near the area that controls left-handed movement. 

“Our plan going into the surgery was that he would be awake and playing the guitar while we were taking out the tumor. We’d be examining him to be sure we weren’t injuring the part that controls hand movement, and the testing of hand movement would be done by him playing the guitar.”

Testing a skill like playing guitar during surgery is not an everyday occurrence.

Dr. Komotar and the Sylvester neurosurgical teams perform awake surgeries several times a week, which equals a couple of hundred times a year. Sylvester’s dedicated neurosurgical center – highly specialized solely for neurosurgical care – is rare among hospitals, and the neurosurgeons, Dr. Komotar says, are just one small part of a team that makes these procedures possible. 

“A case like this spotlights the value of multidisciplinary care,” he says. You can only do these types of surgeries at a place like Sylvester, where there’s a great neurosurgical team with neuro-anesthesiologists, great intensive care specialists, great oncologists – an amazing team of professionals working together.”

Arman Dagal, M.D., chief of Neuroanesthesiology and Perioperative Neurosciences at Sylvester, who provided Nolen’s anesthesiology care during the operation, says disease is a continuing process, so their team strives to provide a continuation of care, not just hospital-based care. The day of surgery is one part of that continuum.

“In a case like this, we establish a relationship with the patient in the preoperative area because we would like them to follow instructions during the surgery. We explain to them what is critical, what we need them to do at certain stages, and what will take place during the surgery,” Dr. Dagal says. 

What happens during an awake craniotomy?

Initially, the patient is put to sleep, and regional anesthesia numbs the scalp for the invasive part of the operation, Dr. Dagal says, and the patient is placed in the proper position for the neurosurgeon to access the area where the tumor is located. 

“When we’re ready, in the critical portion of the surgery when we need them to communicate with us, we wake the patient up and take out the breathing tube. They slowly get oriented to where they are,” Dr. Dagal says. That’s when Nolen was given the guitar and asked to play. He chose Deftones songs for his playlist.

In addition to helping neurosurgeons target a tumor while sparing vital tissues and function, awake brain surgery provides other benefits for patients, Drs. Komotar and Dagal say. 

“It’s shown to improve outcomes, in terms of lower complication rates. Also, patients stay in the hospital for a shorter period of time, and they require less-invasive postoperative monitoring because when they go to the ICU, they’re fully awake, and we can communicate with them,” Dr. Dagal says. “These are all benefits from having less anesthetic and being awake. There’s less chance of nausea and vomiting and greater early mobilization.”

Nolen continues to undergo treatment – the continuum of care that Dr. Dagal referred to – but he has resumed his active lifestyle and is playing guitar again – for fun, having passed his left-handed dexterity tests and ending 2023 on what might aptly be described as a high note.

Kevin McClanahan is a contributor for Sylvester Comprehensive Cancer Center.

Tags: brain tumor care in Miami, Brain Tumor Initiative, Dr. Arman Dagal, Dr. Ricardo Komotar