Neurochirurgen sind wirklich gut darin, Hirntumoren zu entfernen, und sie sind dabei, noch besser zu werden. In einem Schritt in Richtung personalisierter Medizin haben CMU-Wissenschaftler einen einfachen und wertvollen Weg zur Verbesserung von Hirntumoroperationen entdeckt.

>When removing cancerous tissue in the brain, neurosurgeons often use “awake brain mapping” to minimize the risk of causing unintended disruptions to a patient’s quality of life while removing as much tumor as possible. This practice, which has been used for decades, involves waking a patient up mid-surgery to test their neurocognitive functions in real time by stimulating the brain surface and assessing for functional changes.

>A new [study](https://www.science.org/doi/10.1126/sciadv.adw1599) soon to be published in the journal Science Advances details a promising, new avenue toward improving awake brain mapping results by investigating the tiny, nearly imperceptible variabilities in patient behavior that occur during the procedure. This work points to a future where brain surgeries are not just safer, but more precisely tailored to protect each patient’s speech, movement and quality of life.

>As cancer grows in the brain, it rarely keeps to itself. Cancerous cells can be found in the seemingly healthy brain tissue surrounding a tumor, presenting neurosurgeons with a dilemma. They need to remove as much tissue infiltrated by cancer as possible, but they also need to avoid the removal of too much tissue since it can cause permanent harm to a patient’s ability to hold a fork or conversation.

>During awake brain mapping, surgeons gently stimulate the brain with small electrical impulses while the patient completes planned tasks. One of the most common applications of awake brain mapping is to identify where language is represented in a patient’s brain, which is done by having the patient name pictures or read words while their brain is being stimulated. If the patient can respond quickly and correctly, the clinicians know the part of the brain they stimulated can be safely removed. If the patient slurs or becomes unable to speak, then that part of the brain may be essential for language. Surgeons require a significant amount of experience to understand the nuances of this complex technique.

>While the method may sound extreme, the brain has no sensory nerves, so patients do not feel their brain surgery as it is happening. Recent research also shows that for some types of brain cancer, improving a patient’s quality of life after surgery extends their expected survival into the future. This means that anything that can make awake brain mapping even more effective will translate into improved outcomes for brain cancer patients.

Interesting that in these brain surgeries, a neuropsychologist (or equivalent) becomes part of the surgical team to help assess brain function during surgery.