科技前沿----清醒开颅术实录 [美国媒体]

“Brittany, name the days of the week.”

“布兰妮，说说一周有哪几天。”

“Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday.”

“周日，周一，周二，周三，周四，周五，周六。”

“What do you shave with?”

“你用什么刮毛？”

“Razor.”

“剃刀。”

“What color is grass?”

“草是什么颜色的？”

“Green.”

“绿色。”

“What color is the sky?”

“天空呢？”

“Blue. You just asked me these questions.”

“蓝色。你刚才已经问过这些问题了。”

It’s thethird round of this and Brittany Capone, 24, is rankled by the repetition. Herirritability is actually a very good sign; it means she’s alert andcommunicating normally, regardless of the fact that she’s lying in an operatingroom at Memorial Sloan Kettering Cancer Center with a tangerine-sized flap ofher skull cut open.

这是24岁的布兰妮•卡彭第三次重复这一流程。她的不耐烦其实是一个不错的信号，意味着她仍是警醒的并能进行正常交流。这一切都没什么问题，如果不去考虑她正躺在MSK癌症治疗中心的手术病床上并有一半颅骨是切开的话。

Capone ishaving open-brain surgery to remove a tumor that’s dangerously close to aregion in the brain that controls speech and the ability to comprehendlanguage. And by doing the operation while Capone is awake and speaking, hersurgeon, Dr. Philip Gutin, can figure out exactly where the offending growthends and the area of the brain called the Wernicke’s center begins. This way,Gutin can see how close he can cut without permanently affecting his patient’sability to talk.

卡彭正在进行一台开颅手术以便切除一个肿瘤，该肿瘤位置非常靠近大脑控制语言和说话的区域。她的主治医生菲利普•古丁博士可以通过术中与卡彭的交流对话来准确判断大脑中语言区的范围，该区也被称之为韦尼克区。由此，古丁可以在术中判断他如何才能在不损坏患者语言能力的前提下精确地进行切除。



Brittany Capone, with electrodes attached to her head that will help surgeons map where her brain tumor lies.

布兰妮·卡彭，通过头上的电极来帮助主治医生发现肿瘤位置。

Awakesurgery was pioneered decades ago in epilepsy patients: surgeons would keeppatients alert enough to ensure they were destroying the tissue in the brainthat caused uncontrolled seizures. But it wasn’t until the recent introductionof brain-mapping technology—which allows doctors to create a precise digitalreplica of a person’s brain cartography—and highly sophisticated anestheticsthat more surgeons became comfortable with the idea of waking their patientswhile they operated. “There’s growing interest in awake surgery nationally andinternationally for sure,” says Gutin.

清醒手术在数十年前就已经应用于癫痫患者身上：手术时保持患者清醒状态以确保他们的癫痫病状组织可以被完全去除。但是直到最近，大脑图谱技术成熟后才允许医生对人类脑部进行精确的数码成像制图并进行高度精确的局部麻醉。所以现在越来越多的脑部手术开始倾向于让患者清醒时进行。“毫无疑问，不管是国内还是国际上，清醒手术都越来越受到关注。”古丁医生表示道。

Now, it’sthe go-to surgery for many kinds of brain tumors, especially ones, likeCapone’s, located so close to the speech center. Removing it while the patientis completely sedated wouldn’t be an option anymore, says Dr. Emery Brown,professor of anesthesiology at Massachusetts General Hospital and HarvardMedical School. “That would just be wrong.”

现在，多种脑部肿瘤手术都采用这种方式，尤其是像卡彭这类靠近语言区的肿瘤手术，全身麻醉已经不再是选项之一。麻省综合医院及哈佛医学院麻醉学教授艾莫里•布朗博士说道：“全身麻醉本身就是错的。”

It alsomeans Nicole Brennan, a neurodiagnostic fMRI specialist, will continue firingquestions at Capone until Gutin is satisfied that he knows exactly how far hecan go to remove her growth. “How many things in a dozen?” “Name something youwrite with.” “Name something to sit in.” Capone, whose responses so far have beenlightning fast, hesitates just a moment before saying “chair.”

​这同样意味着神经诊断核磁共振成像专家尼克•布莱南可以继续帮助卡彭和古丁医生解决如何切除肿瘤的问题。“一打是几个？”“说一样你写字的工具。”“说一样可以坐的东西。”卡彭回答的都很快，在回答“椅子”的时候稍稍犹豫了一下。

Theoperating team starts buzzing. That brief pause indicates that Gutin is gettingclose to the Wernicke’s area, in Capone’s left cerebral cortex. Damage to thatarea could leave Capone unable to understand or use language for the rest ofher life.

手术团开始低声讨论，这短短的停顿意味着古丁已经接近卡彭的左侧大脑皮质中的韦尼克区。该区域的损伤可能导致卡彭这辈子无法理解或使用语言。

“Name something you paint with.”
“Uh, paintbrush.”

“说一样你可以画画的工具。”
“呃，画笔。”

Thatsatisfies Gutin and his team. They now know where the no-go zone is, and theymark it on the digital mapping system that, sort of like a neural GPS,documents every inch of Capone’s brain. “The motor and speech areas are twothings we are particularly cautious about,” Gutin says later, since hemiplegiaand aphasia—the inability to speak—are two of the possible outcomes. Once theydelineate where they will cut to remove the tumor, Capone’s dose of theanesthetic propofol is increased again and she’s back asleep while the growthis removed.

古丁和他的团队满意了，他们现在知道了哪里是禁入区，他们在大脑图谱系统中标识出了该区块----这个系统就好像GPS一样，将卡彭大脑中每一个区域分块。“运动和语言区块是我们尤其注意的两个区块。”古丁之后表示道，因为半身不遂和失语症是手术的两大后遗症之一。一旦他们决定好从哪里切除肿瘤，卡彭的麻醉剂剂量就会增加，她将会重新陷入沉睡，直到切除手术完成。



Capone’s surgeons probed her brain while she answered questions so they could avoid touching her language areas while they removed the growth in her brain.

卡彭的医生们在她回答问题时用探针刺探她的大脑，以此来避开语言区。这样在切除肿瘤时就不会碰到这一区块。

Thatflexibility in controlling the patient’s awake and unconscious states comesthanks to new drugs and techniques that shorten the time anesthesiologists needto make that happen. In Capone’s case, it took around 15 minutes to wake herand just a few minutes until she was asleep again. “With today’s techniques,it’s really almost like flipping a light switch,” says Dr. Robert Harbaugh,director of the neuroscience institute at Penn State and president of theAmerican Association of Neurological Surgeons. “The patient can be asleep one minute and awakethe next.”

这种灵活控制患者清醒和麻醉状态的技术得感谢最新的药物和科技，这减少了麻醉师所需要的生效时间。在卡彭的例子里，唤醒她需要15分钟而重新麻醉只需数分钟。“通过今天的最新科技，麻醉就像是按电灯开关一样。”来自宾夕法尼亚州神经系统科学研究院及美国神经系统科学外科医生协会的罗伯特•哈堡博士说，“患者这一分钟在沉睡，下一分钟就可以醒来。”

But headmits he was a bit wary of the idea at first. Some surgeons recall rare butnightmarish stories of patients who report being awakened unintentionally whileunder general anesthesia; they can feel everything but they can’t speak or movebecause they’re paralyzed by the anesthetic. “I had some concerns initially,”Harbaugh says. “What would happen if someone became agitated, and tried to jumpoff the table?”

然而他也承认他最初的时候对于这个想法还是很谨慎的。一些手术医生反映过某些患者在全身麻醉的过程中无意间醒来，他们能感觉到一切但不能开口说话做动作因为他们被麻醉剂麻醉了。“刚开始我有些顾虑，”哈堡说，“如果有些患者突然很激动，甚至想要跳下手术台呢？”

His fearswere unfounded, and instead, awake surgery is increasingly proving to be auseful way of helping surgeons to perform more precise, less damagingprocedures. Neurosurgeons applying or board certification are now asked aboutawake surgery techniques on their oral exam. “Even a few years ago, it was veryrare to see those cases on an oral board exam,” says Harbaugh.

他的顾虑最终没有成为现实，相反的，清醒手术越来越成功地证明了它在外科手术中能提供更精确的定位并造成更少的损伤。神经外科医生现在在专业领域证书的测试中已经开始被问到清醒手术相关技术的问题。“仅仅数年之前，这类问题还很少出现在测试之中。”哈堡说道。

And it’sexpanding beyond the brain as well. Awake surgery is used by head and necksurgeons who implant prosthetic devices to replace damaged vocal cords, forinstance. Having the patient awake and speaking helps them to place the deviceproperly and restore their ability to talk comfortably. Orthopedic surgeons alsoawaken patients when they operate on damaged spinal cords, asking patients towiggle their toes to ensure they haven’t accidentally damaged critical motornerves running along the spine.

现在，这项技术也扩展到脑部手术之外。清醒手术现在也同样被头部和颈部外科医生所使用，他们用这项手段来替换声带等。举例来说，患者在清醒时说话可以帮助他们更好的替换发声器官，并更好的帮助他们恢复舒适的谈话能力。矫形专家们现在也在脊髓修复手术中使用清醒手术，他们让患者摆动脚趾来确保他们不会在手术时意外地伤到脊柱附近的运动神经线。

Meanwhile,what neurosurgeons are learning through mapping and documenting theirexperiences, for example, is also informing general knowledge about where brainstructures are located and the slightly different positions they can take indifferent people.

与此同时，神经外科医生们也在通过图谱和记录仪来学习，这也在帮助他们了解大脑完整结构的整体知识，并定位不同人群的不同细微位置差别。

ForCapone, the idea of being awake during her operation was more intriguing thanscary, and like most awake-surgery patients, her biggest concern was whethershe’d feel anything. With brain surgery, that’s not an issue since neurons inthe brain don’t have pain receptors, so as long as the scalp is numbedproperly, patients don’t “feel” anything the surgeons are doing in the brainitself. Headaches, when they do happen, are caused by pressure build up in theblood vessels, or inflammation of the muscles or nerves in the scalp.

对于卡彭来说，清醒地完成手术显得有趣多于恐怖。就像多数清醒手术患者一样，她最大的担心来自于她会不会感觉到疼痛。对于脑部手术来说，这并不是问题，因为大脑不包含任何痛觉神经。只要头皮麻醉不出问题，医生在做脑部手术时患者不会有任何痛楚。头痛这类问题通常是由血管或肌肉发炎以及头皮神经引起的。

In theend, the only dismay wrought by the surgery, says Capone, is the fact that shedidn’t get to watch the entire procedure on a screen in real time. “Will I getto see the tumor before you send it for biopsy?” she asks about 20 minutesafter her brain was opened. The answer was no.

最后，对于卡彭来说最遗憾的莫过于没有亲眼在屏幕上看到整个过程。“我能在肿瘤活体切片之前看一眼吗？”她在开颅20分钟之后问道，当然答案是否定的。

There wasgood news to come, though. The small sample Gutin tested turned out to bebenign.

不过也有好消息，古丁医生检测了肿瘤活体切片，结果是良性的。

Caponewent home four days later, and was back at work in a couple of months. “I’mdoing great,” she says. “It’s like nothing ever happened.

卡彭四天后回家了，并在几个月后重新回到了工作。“我现在一切都好，”她说道。“就好像啥也没发生过一样。”