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    Senator Kennedy Awake During Brain Surgery

    By Jennifer Huddleston, staff writer       Edward M. Kennedy, a Massachusetts senator since 1962, was diagnosed with a cancerous brain tumor May 20 after suffering a seizure at his Cape Cod compound. [1] A biopsy found that Kennedy’s tumor is a type of malignant glioma, which, according to the National Cancer Institute, accounts for more than half of the 19,000 brain tumors diagnosed each year in the U.S. [2]

    Kennedy, 76, was awake for portions of the three-and-a-half-hour surgery at the Duke University Medical Center in Durham, N.C., on June 2, during which surgeons had to navigate through the brain to remove as much of the tumor as possible. [3]

    “Senator Kennedy was awake during the resection and should therefore experience no permanent neurological effects from the surgery,” said Kennedy’s surgeon, Allan Friedman. [4]

    During such a procedure, called an awake craniotomy, a patient is kept awake while surgeons remove the tumor to allow doctors to test the patient’s neurological functions and determine if surgeons are nearing a part of the brain that controls certain speech or motor functions. [5]

    During the procedure, neurologists ask patients questions, have them speak or carry on conversations and ask them to perform certain activities such as moving hands or feet to make sure the patient’s brain is not injured during the removal of the tumor. That way, if a patient shows signs of weakening abilities, the surgeons can stop the procedure. [6]

    Kennedy was awake for the removal of the tumor and experienced no pain, despite the lessening of the general anesthesia, due to local anesthesia and the fact that the human brain has no pain receptors. [7]

    Typically, patients are heavily sedated during other parts of the procedure, which includes the scalp incision, drilling into the skull to remove bone and opening the dura, the membrane that encapsulates the brain. Kennedy’s doctors did not say if he was awake during that part of the operation. [8]

    While awake, the patient’s head is secured in a halo, or vice-like device, and must lie still while the surgeons remove the tumor. [9]

    “An awake craniotomy is not a painful experience, but it’s a bit disconcerting,” said Vivek Deshmukh, the director of cerebrovascular and endovascular neurosurgery at George Washington University. [10]

    Even though the procedure is not painful, it can be stressful for patients because they are aware of what is going on.

    “Patients may feel that there’s some manipulation up there, but it’s not a painful sensation and the tumor removal itself they really have no awareness of. But it’s unnerving for the patient, typically, so it’s only reserved for when you’re really concerned about the potential for injury,” said Deshmukh, who performed brain surgery on South Dakota Senator Tim Johnson in 2006. “And particularly for someone who is facing shortened survival, the last thing you want to do is to leave him or her incapacitated for that period of time. Having Senator Kennedy lose his speech, for example, would be devastating to him.” [11]

    According to Deshmukh, the goal of a surgery like Kennedy’s is a gross total recession, or the removal of more than 95 percent of the tumor, but that can be difficult depending on where in the brain the tumor is located and how far it has penetrated. [12]

    “The amount of tumor you remove during surgery heavily influences the potential for long-term survival,” Deshmukh said. [13]

    Kennedy now faces a combination of radiation treatment and chemotherapy to shrink and control the remaining portions of the tumor. [14]

    According to the American Cancer Society (ACS), the incidence rate of malignant gliomas increases with age, peaking in adults ages 75 to 84. The ACS lists the cell type, the aggressiveness of the tumor and the patient’s age as the most important factors in determining the prognosis of these tumors. The ACS also notes that survival rates decrease with age. [15]

    [1] Belluck, Pam & Hulse, Carl. Senator Kennedy Has Malignant Brain Tumor. The New York Times. May 20, 2008.

    [2] Paul, Katie. Under the Knife. June 2, 2008.

    [3] Childs, Dan. Brain Surgery: What Kennedy Experienced. ABC News. June 2, 2008.

    [4]  Ibid.

    [5] Paul, Katie. Under the Knife. June 2, 2008.

    [6]  Ibid.

    [7] Childs, Dan. Brain Surgery: What Kennedy Experienced. ABC News. June 2, 2008.

    [8]  Kennedy’s Brain Surgery Is Risky, Doctors Say. June 2, 2008.

    [9]  Ibid.

    [10] Paul, Katie. Under the Knife. June 2, 2008.

    [11]  Ibid.

    [12]  Ibid.

    [13]  Ibid.

    [14]  Kennedy’s Brain Surgery Is Risky, Doctors Say. June 2, 2008.

    [15]  ACS Statement on Senator Edward Kennedy from Otis W. Brawley, M.D., Chief Medical Officer, American Cancer Society. American Cancer Society. May 20, 2008.

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