Dr. Alfredo Quiñones Hinojosa

pain you can possibly imagine doing microscopic movements to separate a small little blood vessel that is the size of a hair.

But you know that that little blood vessel could potentially mean the difference between memories or no memories, speech or no speech, motor function or no motor function.

So that's how you take your time and your patience and you're listening to

to the orchestra, the symphony of the operating room, and you're moving your hands and your nurse predicts

The instrument that you're going to need is small little microscopic scissors, small little microscopic, very sharp instruments that may look like a little scoop, small little instruments that may look like a little spatula that moves a blood vessel, the brain, or sometimes you use small little devices that cauterize small little vessels.

They look like tweezers and you're getting together and you're moving around.

Well, Dan, the reason why being awake is important for me in my specialty, because I do brain surgery.

There are brain surgeons who do epilepsy.

There are brain surgeons who do vascular neurosurgery.

I do brain tumors.

And the majority of the brain tumors that I do are intricately damaged.

related and adjacent or sometimes invading and penetrating parts of the brain where speech function is important, where motor function is important, where sensory function is important, where vision is important or memory is important.

And there's no machine then in the world that can monitor those functions better than

than the patient's own brain so what i tell patients when they ask me why do we need to do this surgery awake i said because your brain is the best neural monitoring technique that i have available in the world to be able to do the best surgery for you so is the idea that

100%.

I zap this little area and suddenly the patient stops talking and I know, oh my gosh, I should not take that out.

So over the years, what we began to realize is that the brain has function, is organized, has eloquence, has parts of the brain that are like oceans where we have no idea what kind of function is there.

So the way I deal with my patients, I ask the question, you know, I recently had a patient that mathematics accounting was very important for him.

And we needed to make sure that we preserve that function to the max.

So before going to the operating room, we did maximum amount of testing to maximize the test that we could do in the OR that will maximize that function preservation.