Preserving Fine Motor Function in Brain Surgery

"The violin is my passion. I've been playing since I was ten years old. The thought of losing my ability to play was heartbreaking."
"Being a musician himself, Professor Ashkan understood my concerns. He and the team at King's went out of their way to plan the operation -- from mapping my brain to planning the position I needed to be in to play."
"Thanks to them, I'm hoping to be back with my orchestra very soon."
"[Doctors told me], 'Your tumor is on the right-hand side, so it will not affect your right-hand side, it will affect your left-hand side'. And I'm just like, 'Oh, hang on, this is my most important part. My job these days is playing the violin'."
Dagmar Turner, British violinist

"[The operation had forced his team to consider the] finer details [of violin playing]. Length of the string, pressure on the string, all those fast movements moving from one string to another."
"So that is what was unusual for us."
"We perform around four hundred resectons, tumour removals, each year, which often involves rousing patients to carry out language tests, but this was the first time I've had a patient play an instrument [during surgery]."
"We knew how important the violin is to Dagmar, so it was vital that we preserved function in the delicate areas of her brain that allowed her to play."
"We managed to remove over 90 percent of the tumour, including all areas suspicious of aggressive activity, while retaining full function of her left hand."
Dr.Keyoumars Ashkan, neurosurgeon, King's College Hospital, London

Dagmar Turner recently played her violin during brain surgery in London. "The violin is my passion," she said in a statement. "I've been playing since I was 10 years old."

King's College Hospital NHS Foundation Trust/Screen shot by NPR

Unusual, and rare that a musician would actually play their instrument during surgery, enabling surgeons to map the brain to distinguish which area would be affected through surgery so that steps could be taken to carefully avoid disturbing the area in question for the purpose of retaining the artist's ability to continue performing. There have been a few previous instances of neurosurgery that set about to produce a result very similar to that of this 53-year-old violinist who was determined to retain her ability to play a violin.

The surgery scheduled for DagmarTurner at King's College Hospital, London was to remove a tumour on her right frontal lobe. Which left her with the fear that post-surgery her ability to play her beloved violin might be compromised. As a member of the Isle of Wight Symphony Orchestra she was intent on doing all that was possible to make certain that no damage to the area controlling fine movement of the left hand -- a requirement for skilled, intricate violin playing -- would occur.

She discussed her fears with lead surgeon Keyoumars Ashkan and out of that discussion came the plan of action. As an accomplished pianist himself, Dr.Ashkan was compassionately invested in doing whatever he could to preserve Ms.Turner's left-hand neural controls. It was agreed that she would be awakened from a general anesthetic so she could play her violin once the team had conducted the craniotomy -- opening the skull. It took two hours with Ms.Turner playing all the while for her brain to be meticulously mapped.

While she played scales and improvised melodies and music compositions from memory, the parts of the lobe to be preserved for its necessity in controlling the left hand, were precisely identified. The violinist had been diagnosed with a large, slow-growing tumour, a grade-2 glioma, in 2013. During a public performance she had suffered a seizure. The tumour was identified as benign, but once it began to aggressively take on size despite radiotherapy, the decision was taken to remove it.

The surgical team had inserted a tiny electrical probe, activating it to determine whether it disrupted Ms.Turner's ability to playi with the understanding the surgeons could remove tissue where activation would not affect her playing ability. The procedure was repeatedly followed as the tumour was removed. Surgery was pronounced successful, following which Ms.Turner returned home in three days' time. Within two and a half weeks, she was able once again to take up her place with the orchestra.

After surgeons removed a tumor from Dan Fabbio's brain in 2017, they gave him his saxophone — to see whether he'd retained his ability to play. A year after his surgery, Fabbio is back to work full time as a music teacher.

YouTube/Screenshot by NPR