Volume 2 : Issue 2
After hearing the story of Patti Fantaske, a local woman whose successful spinal surgery was performed by James Fick, M.D., a neurosurgeon from the nationally ranked Penn State Hershey Neuroscience Institute, I knew I wanted to learn more.
During the hours of surgery I was invited to observe at Dr. Fick’s practice at Mount Nittany Medical Center in State College, Pennsylvania, I was struck not just by the operating room
full of specialized technology but also by the vulnerable and delicate nature of the human body. It turns out that the same body that can so capably climb mountains and run marathons can also be robbed of its ability to walk, not just by an injury, but also by the slightest error in the movement of a surgical instrument next to a nerve. One millimeter can mean the difference between walking or not walking and, even, between life and death.
The Day of the Surgery
“You have to remember where people are coming from. They haven’t slept for three days; they’ve spent a week wondering if they have a brain tumor; and out in the parking lot they’re imagining their kids aren’t going to get to see them grow old,” Dr. Fick tells me as we wind our way to Operating Room 6 through a series of hospital corridors, sharp bends, and swinging doors.
The operating room (OR) is Dr. Fick’s domain, the place where he and his highly skilled team of nurses, technicians, and anesthesiologists come together to care for the people who put their lives in their hands.
Dr. Fick is about to perform surgery at the base of a patient’s spinal cord, where the nerves begin to separate into tiny, seemingly infinite pathways—splitting into a bundle of rootlets that control motion in the hips, knees, ankles, and more. This bunch of nerves (referred to as the cauda equina in Latin) resembles the collection of individual strands that make up the tail of a horse.
We arrive at the entrance to the OR, and, except for a pair of neon red and yellow sneakers, Dr. Fick shrouds himself entirely in blue. His focus is palpable as he hunches over the trough-like sink to scrub in. A fragile, nearly invisible, soap bubble floats past our heads as he rubs his hands together. While the bubble performs its final disappearing act, I think of the delicate nature of the procedure to come.
Two nurses wheel the sedated patient past me and into the operating room. Minutes later, the patient’s steady heartbeat begins to sound throughout the room.
Scalpel in hand, Dr. Fick makes an incision.
The Heart of the Matter
“I’m from rural Iowa. My father’s a veterinarian, and my grandparents were dairy farmers,” recalls Dr. Fick during our first meeting weeks before the surgery.
He’s dressed in a mustard-colored tweed suit and a buttercup plaid shirt. As I sit across from him under the buzzing fluorescent lights of the hospital, it’s hard for me to imagine the neurosurgeon working the graveyard shift at a steel mill, as he assures me he used to do.
Today, it’s more likely that he’s removing a metastatic tumor from a brain, a herniated disk from the thoracic spine, or an intraspinal lesion. After speaking with Dr. Fick for just a few enlightening minutes, it’s apparent that “complicated” is an understatement when the brain and spinal cord are involved.
Dr. Fick is lauded locally for his dedication to his job and is considered a blessing by his patients. In a relatively small community like State College, Pennsylvania, with a population of about 40,000 people, it’s rare to have access to a local neurosurgeon. A university town, State College is nestled in the center of the state and is home to the Mount Nittany Medical Center, where Dr. Fick performs his surgeries as part of the Penn State Hershey Neuroscience Institute.
Looking through the hospital’s windows toward the rolling hills that span the pastures between the medical center and Penn State’s Beaver Stadium, Dr. Fick describes his early impression of State College.
“I was a boy watching a Penn State football game, seeing aerial shots of State College from the Goodyear blimp. In Iowa, the pastures are pool-table flat, and I remember this picturesque town in Pennsylvania and believing that the cows literally roamed around on what I thought were mountains,” Dr. Fick says.
“Oh, to be able to see it through the eyes of a child again,” he trails off.
Dr. Fick graduated from Iowa State University, attended the University of Iowa College of Medicine, and did his residency and internship at the University of Cincinnati in 1992. He completed a fellowship in neuro-oncology at the University of California San Francisco in 1996, working alongside a group of world-famous neurosurgeons.
In 2004, Dr. Fick was recruited through a collaborative effort, which included the Penn State Milton S. Hershey Medical Center, to open a neurosurgery practice in State College. Ever since, Dr. Fick and his team of operating room nurses and electrophysiological monitoring technicians have been leveraging a unique combination of technology—including spinal cord monitoring tools and an innovative image-guided system—to perform hundreds of procedures every year.
“I like the opportunity here. There’s a tremendous amount of opportunity to make a difference—to define a way of practicing,” the Iowa native explains.
The sudden ringing of his phone breaks the melodic cadence of his soft voice.
“It’s a patient’s father. Could I get this?” Dr. Fick politely asks, though he’s almost already out the door.
Suitcases and Safety Belts
On a soppy, gray day, as autumn folds into winter, I have coffee with one of Dr. Fick’s former patients, Patti Fantaske, who sits across from me, her foot tap tap tapping against the tall café stool.
Fantaske’s road to Dr. Fick began with a car accident when she was just a teenager.
It was the summer of 1977 in Pittsburgh, Pennsylvania, and Fantaske was driving through the city in her apple green Datsun B210 with the windows down, listening to an 8-track of Frampton Comes Alive!
“I was on my way to pick up a suitcase from my older sister who borrowed it for her honeymoon in the Poconos, but I needed it for my upcoming week at band camp,” says Fantaske. “One minute I was driving and the next I saw a flash.” An emerald green pickup truck had barreled into the front end of the petite Datsun.
“I remember hitting my head on the dash, passing out, then waking up staring at an embankment on the side of the road,” she says. The car was a mangled piece of steel and shattered glass.
“As I opened my eyes after the crash I knew I was lucky to be alive,” she continues. “Seat belts weren’t legally required at the time, but I was wearing one.”
Wearing that seat belt was probably one of the best decisions she’s ever made.
Fantaske’s 16-year-old self would never imagine that one split second would forever be a defining moment in her life. After spending three nights in the hospital (neck brace and all), she missed the bus to band camp that summer. And not until nearly thirty years later, did the accident’s lasting physical effects truly reveal themselves.
A Natural Beginning
“You are only as good as your last operation,” Dr. Fick humbly tells me, thwarting my inquiries about his past accomplishments (though I’m sure the list is long).
Dr. Fick’s work begins and ends with his patients. Like so many doctors, it’s clear that he didn’t choose his profession for any reason other than to help people get better.
“Everybody thinks that everyone’s opportunities in life are the same, but they’re not,” Dr. Fick says. “To be honest, I was very lucky.”
Growing up in a working-class environment, Dr. Fick had opportunities as a boy often inaccessible to today’s youth. One of five children, the clan had unlimited access to a farm, animals to play with, babbling brooks, hands-on jobs, and salt-of-the-earth kinds of people. A competitive spirit and a love of nature grew within them all.
During college in the 1980s, Dr. Fick worked nights—the infamous graveyard shift—at a local steel mill. “It was brutal, but you learned how to work hard,” he recalls.
“The steel mill was great on-the-job training to be in neurosurgery. It taught me how to stay up all night with a team and work in difficult, sometimes dangerous circumstances,” Dr. Fick explains.
For the now-neurosurgeon, these experiences with peers, college jobs, and medical training translated into valuable life lessons that continue to influence the philosophy behind his neurosurgery practice today.
“I think because I’ve had a lot of jobs and understand the dynamics of the workplace, it helps me to understand personalities and both sides of a lot of fences,” Dr. Fick says.
And he’s seen it all—the good and the bad.
“When you live in a big city, and you’re in training at a big hospital, you lose your youth,” Dr. Fick says. “It just blows you away because of all the awful things you see over, and over, and over again. Whether it’s the horrific things that people do to each other; innocent children with horrible diseases they won’t survive; grieving families at the end of somebody’s life, someone they really loved—it never gets any easier to witness.”
“So it’s a harsh, difficult field, and I’ve learned how unpredictable life can be,” continues Dr. Fick. “And yet we all still like to think we can imagine the next ten days of our lives.”
Luckily for Fantaske, Dr. Fick was there for her on that tenth day.
Summer Love and Winter Blues
One month after graduating from high school in Pittsburgh, Patti Allison met Bob Fantaske at a bar in West Virginia. He was a Penn State student at the time, while she was getting ready to attend Penn State in the fall.
Fantaske tells me she married her husband at the age of 20 and that it was the easiest decision she ever made. “When you meet the man you want to spend the rest of your life with, you marry him,” she says matter-of-factly.
Years later, around Christmastime, the couple and their two not-quite-grown boys found themselves remodeling their circa 1987 master bathroom.
“White dust and little pieces of Styrofoam were falling down around me like the snow outside as I scraped the popcorn plaster pieces off the ceilings,” Fantaske remembers. “That was when the back pain first started. There was just something about that arm motion.”
Fantaske and her husband knew something was definitely wrong when she also began experiencing numbness around her side and back, while the sharp pain in the middle of her back got worse. When the pain finally became constant, Fantaske was forced to contort her body into a single position on her side for any relief.
A search for an explanation (and cure) was quickly at hand. Over the next few weeks, a slew of doctors, physical therapy sessions, and X-rays ensued. Bob Fantaske accompanied his wife to every single one of her appointments.
Finally, a magnetic resonance imaging (MRI) scan was ordered.
A couple of weeks after the test, the phone rang in Fantaske’s kitchen. “We found something on your MRI,” a nurse on the other end of the line told her. “There’s something growing inside your spine. We don’t know what it is. We’d like you to go see a neurosurgeon,” the nurse continued.
That’s when the panic set in for Fantaske. “I immediately thought I had cancer,” she tells me. “My mother passed away from uterine and breast cancer when I was just a little girl, so I’ve always been afraid of that possibility.”
Fantaske was overcome with fear, doubt, and uncertainty for the future. “I spent several days being frightened. I felt like I was going to break down, but I also knew I had to hold it together for my husband and sons,” Fantaske admits.
The growth was causing the debilitating pain by pushing up against Fantaske’s spinal cord and pinching a nerve. Cancer or not, it had to come out.
A Blue Ribbon
Back at his office, Dr. Fick explains that, “Every day, I am one phone call away from somebody’s worst-case scenario. I walk into rooms and somebody I’ve never met is sitting there sobbing.” His voice quiets noticeably.
Dr. Fick imparts his confidence and medical expertise by educating his patients about their conditions. Over the years, he has found that his patients (after seeing sometimes three different doctors in a forty-eight-hour period) have not once been shown the images of their own brain or spinal cord.
So Dr. Fick does exactly that. “How are they going to determine if they should let me drill open their skull and touch their brain if they can’t trust me and don’t even have all the information?” Dr. Fick asks.
“It’s a lot easier to describe the medical situation in a very straightforward way using computer imaging, which allows the pictures to be shown simultaneously and even manipulated,” Dr. Fick explains as he scribbles various views of an MRI image on a piece of paper. “One, two, three—here are the most important views from the MRI. This is what your spinal cord looks like at T2. Here is an image of a patient who doesn’t have what you have at T2. And here is what you look like at T4, which is perfect,” he says, talking to me as if I were a patient.
In conjunction with the computer images, storytelling also plays a role.
“Half my patients can’t wait to go to the Grange Fair in Centre Hall every summer, and they know what a prizewinning tomato looks like. So when I show them the image of their spine, they can agree with me when I say, ‘Right here, you look like you’d take a blue ribbon at the Grange Fair,’” Dr. Fick laughs.
“Nevertheless, it’s serious. It’s significant, and it’s a technically challenging surgery. But I can do it,” he says.
It’s clear that Dr. Fick’s understanding of the human condition just may be his secret ingredient—in addition to his extensive education, years of practical experience, the dedicated team by his side, and the specialized technology at his fingertips, of course.
The job of a neurosurgeon is certainly unpredictable. There is a range of issues and emotions that Dr. Fick faces every day, and not one patient or day is like the last or the one to follow.
“I’ve learned that the first time I meet most patients, they’re way out on the edge of the gangplank. They’re terrified. They’re living their worst-case scenario, and it can sometimes be hard getting them to give up the fear of the unknown,” he says.
Dr. Fick has to figure out in a very short time (minutes, really) who is going to want to know everything that he knows, who is lost in the depths of their fear, who can handle it, and who is going to wreck their family with doubt and uncertainty.
“I tell a patient, ‘I know why you’re scared. I understand. I am confident that this is going to be okay. I’ll take care of you,’” Dr. Fick tells me. “Then I walk down the hall and have to tell someone else they have a tumor they won’t survive and that I’m very, very sorry.”
Despite the stress of the job, Dr. Fick remains an optimist to the core. “Every day is an opportunity to help someone and their family.”
A Collective Effort
“I used to be an avid fly fisherman, but as my responsibilities changed, I became a taxi driver for my three children,” laughs Dr. Fick. “I like to go places in the mountains where no one else goes. I like to go at times when I won’t see anyone—it’s an escape.”
The solitude he enjoys while fishing is comparable to the quiet that resounds in his OR. No rock-and-roll music is allowed, sudden movements could be dangerous, and talking isn’t even all that necessary.
“The bleeding will start, and the nurses will instantly reach for something. I don’t even have to say anything. They immediately know what to do under those circumstances,” Dr. Fick says of his experienced team. “The operations are long and difficult. It’s not a room for everybody.”
“Dr. Fick’s surgeries are on the intense side, but I like that,” says Christa Maney, a registered nurse (RN) who has been a scrub nurse in Dr. Fick’s OR for six of the nine years she has been working in the field. “The procedures are always interesting, so I learn something new every day,” she adds.
Dr. Fick has nothing but compliments for his team. “I have a fantastic team. I’m really lucky,” he says. “The nurses are very devoted to what we do, how we do it, and why we do it.”
“They don’t know how good they are,” he adds. “But, as I continue to remind them, I do.”
Today, like every day, Operating Room 6 is sterile, quiet, brightly lit, and full of specialized machinery. The only sounds are the steady beeping of the patient's heart monitor and the occasional light shuffle of bootie-covered shoes and rubber clogs as the nurses glide from station to station around the operating table. A group of scrub nurses, a certified registered nurse anesthetist, and a monitoring technician are positioned around the room.
For operations that are performed within a millimeter (equal to the thickness of the edge of a dime) of the nerves and spinal cord, electrophysiological monitoring provides extensive benefits to both Dr. Fick and his patients. Such monitoring helps to measure the patient’s vital nerve signals and prevent irreversible injury in areas of the body that may never recover if damaged.
During the surgery, the monitoring technician, Barb Motley, places electrodes within the muscles of the scalp, neck, arms, hands, legs, and feet to activate the patient’s sensory and motor pathways and report on their neurological functioning. She alerts Dr. Fick as to whether he is operating too aggressively or if the patient’s spinal cord or nerves are showing signs of trouble based on second-to-second readings that appear on a laptop screen.
For Dr. Fick, introducing technology into his operating room has resulted in increased confidence, precision, and safety—even allowing operations to be performed that would have been judged inoperable years prior.
Today’s surgery would also not be possible without Dr. Fick’s team members. He relies on them for their knowledge, dedication, and ability to remain calm under extreme pressure. They are responsible for interfacing with the technology in the room; anticipating the needs of the patient and Dr. Fick; monitoring the patient’s oxygen level, heart rate, anesthesia, and neurological functioning; and much, much more.
“Come over here. You should see this,” whispers Dr. Fick to Maney as he’s looking through the operative microscope at a peculiar abnormality eroding the spinal column.
Opportunities for teaching moments are one of the few times during the operation when anyone speaks.
Maney walks to the side of the patient and gently puts her eyes against a second pair of oculars to view an abnormal bone growth that Dr. Fick has just discovered. A quiet conversation takes place between the two of them.
An hour-and-a-half has gone by, yet it seems like only thirty minutes since the surgery began. Dr. Fick steps away from his perch on a spongy red mat to review the patient’s MRI. While studying the screen, he instructs the head nurse to call the patient’s family and let them know that everything is going well.
Back at the table, looking through the eyepiece of the large microscope, Dr. Fick raises his hand slightly and opens his palm. Not a word it spoken, but the surgical nurse, Jamie Baxter, RN, swiftly places the desired instrument into his glove.
Motley, the monitoring technician, breaks the silence in the room as one of the patient’s electrodes begins to signal. “I'm seeing activity in S1,” she calmly says as she studies the readings on her laptop.
Dr. Fick immediately steps away from the table and walks over to a screen to take a closer look at the patient’s MRI and X-ray. He and Motley exchange a few words, and he asks the technician to confer with an off-site neurologist via Internet chat about the issue. During the entirety of the operation, Motley is in constant communication with a remote neurologist who is available to answer questions, discuss the patient’s drug levels, consult regarding any concerns, and more.
“The neurologist says that’s sufficient,” Motley replies after just a few moments. Dr. Fick returns to the patient and continues his delicate work.
“There can be eighteen reasons why the monitoring technician sees a change. When we’re so close to nerves in the spinal column responsible for movement, we want to monitor our progress very carefully,” Dr. Fick explains later that morning. “Any changes that the technician sees in the readings can ultimately change the way I do the surgery. So there’s constant interaction between us.”
The technology changes the whole mood in the operating room, as well as the emotions of the surgeon.
“Most people think that neurosurgery is very cut and dry. They think a tumor is like a grape in the middle of a bowl of Jell-O. No doubt about it, there it is; cut it out,” Dr. Fick says. “And some lesions are that way, but others absolutely are not, which is why the technology is so reassuring during times of very difficult surgery.”
“Honestly, I can sleep better the night before an operation when I know I’ve done everything I can to bring a new element of safety into the procedure using these technologies,” he adds.
The Individual Difference
As I sit with Fantaske once again, she recalls, “The first time I met Dr. Fick, I was expecting someone impersonal, but he ended up being more like a version of TV’s Dr. Marcus Welby. I felt very comfortable with him from the get-go. He’s the kind of doctor who will make sure you understand something before you walk out the door.”
Luckily, the growth that Dr. Fick removed from Fantaske’s back wasn’t cancer. Though it did turn out to be old, degenerative cartilage that had lodged itself in an odd position against her spinal cord, pushing on a nerve. The growth had peculiar blood vessels and was surrounded by tremendous scarring, which had appeared like a tumor in the MRI. After surgery, Fantaske had multiple follow-up scans that confirmed she was cancer-free and that the cartilage didn’t continue to grow.
Dr. Fick and his team are the reason she can walk today.
“The level of patient care I received from the entire staff, both before and after the operation, was something I wasn’t used to at the time,” says Fantaske. “Dr. Fick and his team know you’re scared and upset. They are very reassuring and comforting, and they talk to you like you’re a person and not just another number.”
For Dr. Fick, the primary focuses of his team are biology and people. He believes that patients want a personal attachment to their physicians.
“No one wants to be given care based solely on their weight, height, cholesterol, this, or that. Here, we take into account who our patients are, why they’re unique, and what works for them. They’re not data, they’re people,” he explains as we sit together in his office surrounded by small reminders of nature—rock stacks, wooden bowls, and fishing flies.
The rural Iowa tradition has continued to motivate Dr. Fick throughout his life. “People worked very hard. They felt very fortunate when they had very little. And they wanted to do better,” he says.
“And for me, doing better meant pursuing the opportunity to help others.” ■
James Fick, M.D.
Neurosurgery Meets the Twenty-First Century
Neurosurgery Meets the Twenty-First Century
The Penn State Hershey Neuroscience Institute and the Mount Nittany Medical Center blend a talented team of professionals with specialized technology to provide enhanced care to their patients.
Dr. Fick’s Team
Baxterregistered nurse (RN)
Baxter has been a member of Dr. Fick’s team for six months. In the operating room (OR), she serves mainly as the circulating nurse, but at times will take on the role of scrub nurse. When assisting, she stands beside Dr. Fick throughout the operation, often on tiptoe because of the difference in their heights. Anticipating the surgeon’s needs, she hands Dr. Fick surgical instruments before he even needs to ask.
In addition to keeping the patient under sedation during surgery, Lunsford also monitors the patient’s heart rate, blood pressure, and blood oxygen levels. During surgery she is stationed near the patient’s head where a monitor displays the real time data sent from the monitoring equipment.
As a scrub nurse, Maney wears a sterile gown and gloves as she prepares the instruments required for surgery. When asked how she came to be on Dr. Fick’s team, she says, “The way teams come together in the OR is organic. Everyone rotates through and gets to know each other. No one is really assigned to a specific team, but personalities just click. And people mesh and find a home with who works well with whom.”
Morgan works either as a circulator or a scrub nurse and has been on Dr. Fick’s team for five years. As a circulator, she takes charge of patient care and positioning and ensures that the appropriate equipment and items needed for surgery are available. Before the start of the operation, she verifies the patient’s name aloud and announces the details of the procedure to the rest of the team. Morgan documents each stage of the procedure as it is completed and is responsible for telling anyone who becomes woozy to quickly sit down on the floor. Fainting in the OR would disrupt the entire procedure, create an unsterile environment, and put the patient at risk.
When explaining the role of scrub nurses, Morgan notes that they are prepared to serve any role during any type of procedure. They are in charge of scrubbing—washing and sanitizing hands and arms, passing instruments, and taking measures to create a sterile environment.
Motley has been monitoring neurosurgery patients for eight years. She places electrode “needles” in the patient’s muscles in order to monitor their nerve reactivity and/or to stimulate motor responses during surgery (see “Electrophysiological Monitoring” below). Motley watches the real-time output of this data on her laptop computer, where she is also connected with a remote neurologist via the Internet who is available for consultation, as needed. Motley and the neurologist communicate back and forth using a secure form of instant messaging, which provides Dr. Fick with immediate feedback and answers to his questions.
Motley explains that not all surgeries call for electrophysiological monitoring, but it can be very helpful during complicated procedures that involve removing tumors or operating on the lumbar spine, for example.
Technology - Enhanced Precision in the Operating Room
Technology-Enhanced Precision in the Operating Room
An array of specialized technology is used on a daily basis by Dr. Fick’s select team of nurses and medical professionals. Their OR is specially designed to leverage a unique combination of medical technologies.
An array of specialized technology is used on a daily basis by Dr. Fick’s select team of nurses and medical professionals. Their OR is specially designed to leverage a unique combination of medical technologies.
Magnetic Resonance Imaging (MRI)
Many neurosurgical patients are diagnosed based on the results of their magnetic resonance imaging (MRI) scans, which provide detailed images of the inside of the human body.
Specifically, MRI equipment allows many attributes of the nervous system to be characterized and seen directly in many planes and under a variety of circumstances. Because the body’s heart and nervous system run off of electrical impulses that create electromagnetic fields, the MRI equipment functions by sensing and altering these electromagnetic fields using magnetic stimuli. When applied, these stimuli embellish the contrast between individual parts of the body, which allows them to be photographed in detail.
In the OR, neurosurgeons look through oculars (the eyepieces of a surgical microscope) to see a magnified and illuminated view of the inside of the patient’s incision. The microscope is positioned directly above the operating table, while the surgeon’s magnified view is displayed on several screens throughout the OR. Dr. Fick’s team members watch the screens during surgery and follow along in order to better assist him.
Electrophysiological monitoring provides continuous, instant updates on the function of a patient’s sensory and motor pathways during surgery. The monitoring is especially important in cases where Dr. Fick has to operate within a millimeter (the thickness of the edge of a dime) of his patient’s delicate nerves and spinal cord.
Once the patient is under sedation, a technician inserts electrode “needles” into the muscles of the areas of the patient’s body that could potentially be affected by the surgical procedure. These electrodes can indicate the possibility of nerve impairment by measuring when a nerve “fires” (because the surgeon is operating near it) and when the time increases for a signal to travel to the patient’s brain (in response to an electric stimulus from the electrodes).
The monitoring technician uses a laptop computer to chart a series of electric waves that move across the screen. The waves’ amplitudes are monitored for changes from the patient’s baseline readings taken prior to surgery. When there is a change, Dr. Fick is immediately notified and given detailed information about the location and degree of change indicated by the readings.
Image-guided technology is used during brain operations to locate abnormalities in the brain, such as a tumor. A computer compiles a set of pictures taken before surgery and creates a three-dimensional “map” of the patient’s brain, which includes the tumor or abnormality. Prior to the operation, a neurosurgeon can study this guide and determine the best way to approach the lesion.
In the OR, a sensor is used to help locate benchmarks on the patient (such as the corner of the eye, the nose, or an eyebrow). Using these benchmarks, the computer is able to co-register, or match, the patient’s actual head and brain with the three-dimensional images that were compiled before surgery. This allows the neurosurgeon to know where to make the incision. The neurosurgeon will also use the guide to precisely determine the location of the tumor by measuring distances and directions from the benchmarks to the various edges of the abnormality.
The visual difference between brain matter and an abnormality can be very slight, making the edges of the growth extraordinarily difficult to detect during surgery. When the lesion’s boundaries are not apparent, the computer can accurately show, within millimeters, where the line between normal brain matter and a tumor occurs. Due to this advanced precision, many patients are now able to successfully undergo brain surgeries that would have been considered very risky, if not ill-advised, in the not-so-distant past.
Image-guided neurosurgery is often coupled with brain mapping to increase safety and precision. Once an abnormality has been located in the brain, the neurosurgeon’s next step is to determine what body functions are controlled by the brain tissue at the border of the abnormality. With brain mapping, a special device is used to stimulate the brain adjacent to the growth using a very controlled electrical current. The parts of the body that respond to the stimulus precisely indicate which body functions would be affected by an injury in that region of the brain.