TODAY   |  February 03, 2010

Inside the O.R.: Brain surgery

NBC’s chief medical editor Dr. Nancy Snyderman takes you inside the operating room, where a patient is undergoing deep brain stimulation to treat a disorder known as essential tremor.

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This content comes from a Full-Text Transcript of the program.

MEREDITH VIEIRA, co-host: Back at 8:18 with more of our special series TODAY GOES INSIDE THE OR . So far this week, Dr. Nancy Snyderman has shown us live heart surgery in Cleveland and the birth of a baby boy yesterday in Boston . Well, this morning she's here in New York as Dr. Ron Alterman , director of Functional and Restorative Neurosurgery at the Mount Sinai Medical Center , performs brain surgery. Dr. Nancy , good morning to you.

Dr. NANCY SNYDERMAN reporting: Good morning, Meredith . We are at Mount Sinai . Across this plastic drape, Dr. Ron Alterman , neurosurgeon who has placed a probe in our patient's brain ; Dr. Cho , the neurologist. And you're seeing Ben struggle with this tremor , the left-sided tremor . He is an extraordinary person, an extraordinary man, and we want you to meet him right now. Eighty-one-year-old Ben Culvert suffers from a progressive neurological condition known as essential tremor , or ET , which can cause trembling in the hands, head or legs.

Mr. BEN CULVERT: The tremors started in about 1999 , 2000 . As it progressed, I found that I was having trouble keeping my food on the fork. My whole quality of life became very -- it was very hard to be upbeat when this was with you 24 hours , 7 days a week . That's when I decided to find help.

SNYDERMAN: After an initial surgery on the left side of his brain , Ben regained control of his right hand.

Mr. CULVERT: But it went from this to this, completely no shaking at all. But then I realized how many things you do that need both hands. Like, I wrote out checks with the right hand, I had no problem. But then I couldn't find the envelope with the left hand .

SNYDERMAN: He now hopes to put an end to the shaking on his left hand and get his life back.

Mr. CULVERT: I expect to start using the computer again, even play the piano again. One of the things I can't wait to do is to hug Mela , my little darling granddaughter. That'll be a good feeling.

VIEIRA: And, Dr. Nancy , let me ask you this.

SNYDERMAN: So to show...

VIEIRA: Go ahead, Dr. Nancy.

SNYDERMAN: Go ahead and explain exactly what's going on. Dr. Alterman is standing behind me, he's in a sterile. He has already placed the probe into Ben 's brain . Ben is awake. Dr. Cho is here from neurology. Want to show you again the tremor , and then Dr. Cho will go ahead and, where this electrode is placed, she'll adjust the current to hopefully make Ben 's tremor go away. So, Ben , if you'd lift up your arm...

Dr. CHO: Touch your chin. Then touch my finger. Touch your chin. OK. Take the cup, now bring it to your mouth. Return the cup. OK. So now we're going to try to see what the threshold is.

SNYDERMAN: And now with the electrode already placed in Ben 's brain -- and this contraption around his head important because it keeps his head very, very still -- look at how the tremor has disappeared from Ben 's hand. And that is stimulating that deep probe in the motor area of his brain that now controls the left side. The right side of his brain being the operative side. And looking how well that's going. Now I want to call in Dr. Alterman for a second because, Ron , obviously, the stunning thing here is that you are operating on an awake patient.


SNYDERMAN: And we don't normally think of brain surgery with a patient awake. Why?

Dr. ALTERMAN: Well, if we were to put him to sleep with a general anesthetic , the tremor would go away, so we wouldn't be able to know that we were really in the correct place to stop his tremor . Fortunately, the brain doesn't have the ability to feel pain itself, so we're able to, by simply numbing the scalp, perform this entire operation without a general anesthetic at all.

SNYDERMAN: And the brain has no nerve fibers . The brain doesn't hurt when you operate on it.

Dr. ALTERMAN: The brain itself cannot feel any pain for itself, no.

SNYDERMAN: Let's talk about some of the dicey things.

Dr. ALTERMAN: Mm-hmm.

SNYDERMAN: You also have him awake because we're talking about microns of safety, not even millimeters of safety. Stroke, bleeding, those kinds of things can happen.

Dr. ALTERMAN: Correct. Absolutely. We need to monitor the patient's neurologic function, we need to have him awake in order to do the recordings to confirm that we're in the correct place. And -- but finally, really the issue is whether or not we can stop the tremor , or if we were to get any side effects of stimulation. So if, for instance, we were to get painful -- a painful tingling, it would indicate that we were a little too far back. We could actually adjust our targeting here in the operating room .

SNYDERMAN: And if he doesn't know where he is, or becomes disoriented, cause for concern...

Dr. ALTERMAN: Absolutely.

SNYDERMAN: ...and you stop. So, Ben , let me sneak over here. How are you feeling?

Mr. CULVERT: I'm feeling great.

SNYDERMAN: I have to ask you the obvious, because people are not used to seeing human beings with a big metal contraption around their head. Is it disconcerting?

Mr. CULVERT: For me?


Mr. CULVERT: I don't see it.

SNYDERMAN: You don't see it.


SNYDERMAN: And could you feel anything during this procedure?


SNYDERMAN: All right.

Mr. CULVERT: Well, a little bit, but...

SNYDERMAN: And can you -- your tremor , is it -- does it -- is it stunning to be able to be able to control your hand now where you couldn't a few minutes ago?

Mr. CULVERT: Oh, yeah. I have full control now.

SNYDERMAN: And what does this mean for you then, being able to move this hand?

Mr. CULVERT: A whole different quality of life.

SNYDERMAN: A whole different quality of life. So there you have it, Meredith . I mean, it's extraordinary. And let's just remind everyone, this takes a team from anesthesia, neurosurgery, neurology, extraordinary scrub techs and nurses; a hospital that is dedicated to doing this kind of thing. And of course, patients who understand that being awake during this kind of surgery is sometimes the safest, smartest way to go. But it's an extraordinary breakthrough in neurosurgical medicine.

VIEIRA: Yeah, amazing surgery. And life-changing for people like Ben . And also people with Parkinson 's can benefit from this as well...

SNYDERMAN: That's exactly right.

VIEIRA: ...not just essential tremors.

SNYDERMAN: Yes, and dystonia. And here's where the cool future is going to be, and we're going to follow up with Dr. Alterman soon.


SNYDERMAN: Think of depression, OCD , things like that. The future is really quite bright.