ANYONE FOR PLAYING A MUSICAL INSTRUMENT WHILE UNDERGOING BRAIN SURGERY?
February 24, 2020
Musician performs while surgeons remove brain tumour
February 19 2020, The Times
She has played to countless audiences in the 43 years since first picking up a violin aged ten, but nothing could prepare Dagmar Turner for the most intimate performance of her life.
The musician has become the first person in Britain to have a brain tumour removed while she was awake, sitting up and playing the violin.
As she played George Gershwin’s Summertime to the operating theatre surgeons monitored the quality of her performance to make sure they were not damaging the parts of her brain that control delicate hand movements.
“I improvised tunes that came to my fingers,” Ms Turner, from the Isle of Wight, said. “It was difficult to plan what to play, everything sounds so different. It’s not like standing in my kitchen and playing freely. You have to really concentrate on what is going on around you.”
She had brain cancer diagnosed in 2013 after suffering a seizure during a performance and underwent radiotherapy. In December a test found the tumour had progressed and she was advised to have surgery at King’s College Hospital in south London.
Concerned that it would damage parts of her brain that enabled her to play the violin, she and her neurosurgeon, Keyoumars Ashkan, devised a plan. The tumour was in the right frontal lobe, close to the area that controls the left hand. Not only did basic movement need to be preserved, the surgeon had to protect the fine movement of her left hand that controls violin strings to regulate pitch and timbre.
As a pianist with a degree in music, Professor Ashkan understood immediately. “All other musicians think violinists are amazing. It is not just about the right hand and the bow; the left hand movement is incredible, it gives the quality and tone of the sound. I knew I had to preserve this highly skilled movement,” he said.
“Twenty years ago the priority would have been to preserve basic movement in a patient. We wouldn’t have dreamed of being able to protect the finest, most delicate, most absolute, critical executive aspect of movement needed in a violinist.
“The brain controls all functions and if critical functions such as speech, movement and vision are lost it has a significant effect on quality of life. I have patients who tell me they would rather not live than be paralysed or not able to speak after surgery.”
Ms Turner, 53, and her husband Mat, 47, travelled to London the day before last month’s surgery to undergo complex brain mapping to identify areas that were active when she played the violin and those responsible for controlling language and movement.
She and Professor Askhan decided that after her skull was opened, Ms Turner would be awake and on her suggestion would play the violin. “Dagmar put my mind at rest. If she felt she could do it then I knew I would be able to,” Professor Ashkan said.
The plan was not without issues. “I had come to London without my violin,” Ms Turner said. “Luckily I have a violinist friend who lived near by who offered his instrument and my husband ran over to get it.”
Before surgery she gave the surgical team two instructions — to call her by her first name and to handle the instrument with respect. “I wasn’t scared, I was more excited,” she said. “I just wanted to get it sorted.”
Ms Turner, originally from Germany, was put under general anaesthetic at 9am on January 31. She had to be upright so that when she was woken halfway through the treatment and handed her instrument, she was in the correct position to play. Despite meticulous planning, there were still surprises. “I was standing by her head and when she started playing the bow was moving straight towards me. I had to be creative with positioning so I didn’t get hit in the head,” Professor Ashkan said.
While the surgeon cut away at the tumour, Ms Turner played a collection of random tunes including Summertime, Julio Iglesias’s Besame Mucho and Gustav Mahler’s Symphony No 5.
Professor Ashkan said: “My role as a surgeon was to make sure she played well, which means I had to know the song. I knew Summertime, I knew Julio Iglesisas but then she started playing Mahler’s fifth and I didn’t know it. Luckily the anaesthetist did.”
The surgery was over in four hours and Ms Turner was put back to sleep. “I don’t remember much but do recall someone standing behind my head and saying, ‘Dagmar we have just removed 95 per cent of your tumour.’ I was blown away — it was always assumed to be inoperable,” she said.
After her diagnosis Ms Turner had to give up her career as a retail executive but continued to play violin in the Isle of Wight Symphony Orchestra. Two weeks after surgery she was back playing the violin.
“This is my life, this is what I do in my spare time and I enjoy it an awful lot,” she said. “I hope this encourages brain surgeons and patients to be brave enough to approach things creatively. You could sing a song in surgery, you could play the guitar, you could recite poems or anything you have a passion or love for. If the results are as good as mine, why not?”
Sleepless in surgery
● The singer Alama Kante had surgery in Paris to remove a tumour from her throat in 2014. To ensure that no damage was caused to her vocal chords she was asked to sing during the operation. The Guinean, who lives in France, had only local anaesthetic and hypnosis to help with the pain. She recovered in two months, singing voice intact.
● The South African jazz musician Musa Manzini was asked to play his guitar during surgery to remove a tumour from his brain in December 2018. He was woken from an anaesthetic after a hole had been drilled in his skull and he played several notes on his guitar to guide the surgeons in their delicate task while preserving neural pathways. The team in Durban removed 90 per cent of the tumour.
● In October 2019 Jenna Schardt, 25, became the first person to have her brain surgery streamed on Facebook Live. Surgeons removed a section of her skull and then she was woken up to participate in the broadcast. For 45 minutes viewers tuned in to watch the operation in Dallas, Texas. Schardt spoke throughout the process, smiling and helping doctors map her brain by answering their questions.
Written by Dr. Barry Panter