Doctors say Kennedy was awake during tumor removal

Bravery in the face of cancer? Sen. Edward M. Kennedy has given it new meaning. Few things require as much courage as being wide awake and aware, lying perfectly still for hours, while surgeons methodically slice out bits of your brain.
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Kennedy did just that, in an unusual operation Monday at Duke University Medical Center to treat his cancerous brain tumor.

His surgeon said the operation met its goal: removing as much of the tumor as possible to give the radiation and chemotherapy he'll face next a better chance to help.

The 76-year-old senator now will likely be given medicine to prevent brain swelling and seizures — common complications — and watched for signs of bleeding that could lead to a stroke.

His doctors say no permanent neurological problems are expected — and that may be thanks to the daring surgery he chose.

Most people are out cold, or awake just for part of it.

It starts with surgeons cutting through the scalp, drilling into the skull to remove a bone flap, and slicing open the dura, a leathery membrane, to expose the brain. It's not known if Kennedy was awake during this part of the operation.

The tumor usually is not on the surface, so doctors must find a safe path through the brain to get to it, said Dr. Matthew Ewend, neurosurgery chief at the University of North Carolina, Chapel Hill.

To avoid cutting through vital areas controlling speech, doctors often return the patient to consciousness and stimulate tissue in the planned surgical path with a probe.

"We'll have them do language tests like hold up pictures, name objects, repeat words, hold a conversation," Ewend explained.

After that, the patient is usually put back under while the tumor is cut out, which takes about three to four hours.

However, Kennedy was awake for the removal of the tumor, his doctor's statement says. That usually means local rather than general anesthesia.