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Playing the violin, watching cartoons, and doing crossword puzzles – these are just a few of the activities patients performed during brain surgery under the direction of Roberto Trignani.
Trignani, head of neurosurgery at Riuniti Hospital in Ancona, Italy, was already known for his ‘awake surgery’ techniques, which he has used about 70 times in recent years. But he broke new ground in June this year when a 60-year-old woman prepared stuffed olives while he was removing a tumor from her left temporal lobe.
It was not an easy task – the preparation of the olives, in fact. Known as Ascoli olives, a specialty of the Marche region, they are prepared through a complex process in which the green olives are pitted then wrapped in dried meat, coated in breadcrumbs and fried. The woman, a former cook, made 90 in less than an hour.
During this time, Trignani was operating. Awake surgery allows the surgeon to prevent damage to healthy tissue while treating areas of the brain responsible for speech, vision, and movement. In the case of the olive tree, Trignani and his team were able to remove the tumor from an area of the brain that controls speech as well as from the right side of the body.
“We studied the patient’s life, her routines and her favorite activities to see if there was anything that could be useful in her therapy course,” Trignani told The Guardian. “In this case, the woman was a good cook and, above all, had worked in an area known for the olives of Ascoli. We knew that preparing such olives required significant manual skills, so we figured that getting him to do the olives would be a way to monitor the area of the brain we needed to work on.
The operation went as planned and the woman, who left the hospital after a few days, is recovering well.
Trignani’s unorthodox ideas are not limited to conscious surgery. A brain wave came to him this summer after attending a concert by Emiliano Toso, a musician and molecular biologist who claims to play music at a calming frequency. “Listening to his music, I thought, what would happen if we brought Emiliano Toso’s grand piano into the operating room?” Trignani said.
Toso agreed to play, and in November a piano was brought into the operating room for a four-hour operation to remove a tumor from the spinal cord of a 10-year-old boy. Although the patient is under general anesthesia, Trignani said the encephalogram, which monitors electrical activity in the brain, suggests the boy is perceiving music. When the musical notes were interrupted, he said, the brain patterns changed.
Another of Trignani’s cutting-edge surgeries involved a woman who was blind in one eye and had developed a tumor in an area of the brain that controlled vision in her other eye. The operation took place last year on December 13, the feast day of Santa Lucia or “the feast of light” in Italy. While Trignani operated to remove the tumor, the woman underwent eye tests on a computer screen.
“If we had damaged the area near the healthy eye, it would have gone blind,” Trignani said. “So we decided to do her awake surgery as well – there have only been about five or six such cases in the world. She wrote to me a few days ago, December 13 [2020] approached, saying that Santa Lucia had protected her because she can still see well in that eye.
Trignani said the most satisfying part of his role in awake surgeries was the human connection during operations and the patient’s response afterward. “When you see a patient doing good and they have a feeling of gratitude, that’s the best part,” he says. “Those who become doctors do it as they want to see patients doing well – this mission makes you want to eradicate human suffering.”
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