Glioma Gig Ends on a High Note
A patient’s guitar-playing skills assisted neurosurgeons removing his brain tumor
By Kevin McClanahan
Illustration by Benedetto Cristofani
C
hristian Nolen usually plays guitar on stage. But last December, the professional guitarist played songs from the alt-metal band Deftones while a neurosurgical team at Sylvester Comprehensive Cancer Center worked to remove a tumor from his brain.
Doctors put Nolen to sleep at the beginning of the open craniotomy. Then, he was awakened during a delicate part of the two-hour procedure — called an “awake” craniotomy — to play the guitar. This helped doctors evaluate and protect his manual dexterity while being as aggressive as possible in removing the tumor.
Ricardo Komotar, M.D., the Sylvester brain and tumor neurosurgeon leading the team, explained that Nolen had a tumor called a glioma in the right frontal lobe of his brain near the area that controls left-handed movement.
“Our plan going into the surgery was that he would be awake and playing the guitar while we were taking out the tumor,” Dr. Komotar said. “We’d be examining him to be sure we weren’t injuring the part that controls hand movement, and the testing of hand movement would be done by him playing the guitar.”
Dr. Komotar and the Sylvester neurosurgical teams perform awake surgeries several times a week, which amounts to a couple of hundred times a year. Sylvester’s dedicated neurosurgical center is rare among hospitals, and the neurosurgeons, Dr. Komotar said, are just one small part of a team that makes these procedures possible.
“A case like this spotlights the value of multidisciplinary care,” he said. “You can only do these types of surgeries at a place like Sylvester, where there’s a great neurosurgical team with neuro-anesthesiologists, great intensive care specialists, great oncologists — an amazing team of professionals working together.”
In an awake craniotomy, the patient is initially put to sleep, and regional anesthesia numbs the scalp for the invasive part of the operation, explained Arman Dagal, M.D., chief of Neuroanesthesiology and Perioperative Neurosciences at Sylvester, who provided Nolen’s anesthesiology care during the operation.
“When we’re ready, in the critical portion of the surgery when we need them to communicate with us, we wake the patient up and take out the breathing tube. They slowly get oriented to where they are,” he said. That’s when Nolen was given the guitar and asked to play.
Nolen continues to undergo treatment, but he has resumed his active lifestyle and is playing guitar again — for fun, having passed his left-handed dexterity tests and ending 2023 on what might aptly be described as a high note. 
