Doctors and Patient Describe Rare Awake Craniotomy Surgery at UMH

In early September, Ray Beccaria began struggling to put into words what he wanted to say. A week later, he had trouble reading and thought he might be having a stroke. His wife thought he was just stressed.

The 64-year-old health information management specialist admits he was “scared every day” that his perplexing symptoms would worsen. A CT scan and MRI at University of Miami Hospital confirmed his fears: a glioblastoma was growing in the left temporal lobe of the brain, which controls speech.

But fortunately for Beccaria, who aspires to a second career as a professor, Ricardo Komotar, M.D., assistant professor of neurological surgery and director of surgical neuro-oncology at UMH, resected the tumor while Beccaria was wide awake and able to provide the single most important clue Komotar needed to avoid impairing the patient’s speech: words.

“Because of the location of the tumor, keeping the patient awake allows us to remove as much as possible while avoiding critical areas,’’ Komotar explained at an October 5 news conference at UMH. “Awake is really the only way to do this procedure safely.”

Komotar now leads the team of doctors who perform awake craniotomies on eligible brain tumor patients at UMH. Requiring a precision team of experts, the procedure is performed only at select hospitals around the country. To date, Komotar has performed three of them at UMH, putting the facility among an elite group of medical institutions.

In Beccaria’s case, the tumor was near the critical speech-related area, so, while Komotar applied a mild electrical current to the surface of the patient’s exposed brain, Bruno V. Gallo, M.D., assistant professor of neurology, chatted with Beccaria “about his job, his family, asking him to count.’’ When the stimulation affected Beccaria’s speech, Komotar knew to avoid cutting into that area.

Describing the operation to a roomful of reporters and TV cameras just 13 days later, Beccaria spoke clearly as he calmly detailed how he was aware, could sense pressure, but felt no discomfort. There “was no pain, but I could see all the tools and what they were working on,’’ the father of two said. “It was amazing.”

Maintaining that delicate balance between being awake and feeling no pain fell to Thomas Fuhrman, M.D., professor of anesthesiology, who develops a rapport with awake craniotomy patients as they are wheeled into the operating room fully awake. He administered a sedative to Beccaria before Komotar made his first incision to remove intrusive bone, and then administered another medication to wake him up. “We adjust levels of medication to make sure he is safe and comfortable the whole time,” Fuhrman said.

Komotar, who is also co-director of surgical neuro-oncology at Sylvester Comprehensive Cancer Center, said diagnosing tumors like Beccaria’s early is critical because they tend to progress rapidly.

Gallo described the constant communication between the surgical team, himself, Komotar and Fuhrman as “a beautifully choreographed dance.” That dance, combined with brain mapping, has allowed this same team to remove tumors located near the motor region, preserving the patient’s ability to move. As Gallo told reporters, “The brain is where we live.”

Beccaria will undergo chemotherapy and radiation as part of his treatment plan, but says he “feels progress every day” and hopes to return to school. “If I continue to improve, I can go on and become a professor as I wanted.”

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