Dr. Gary Steinberg

We can map it out on an MR scan.

And the way it's mapped out is we have the patient awake, talk to us when they do the scan.

And because there's a coupling between blood flow and the neuronal activity, when the speech area, the language area is stimulated by talking,

there's increased blood flow to that area, and we can see that on an MR scan.

That's how the MR scan works.

So we had some idea that this was very close, if not in the speech area, but the most accurate way of determining that is to operate on the patient with her awake.

So what we did was we sedate the patient.

We don't put a tube down and induce general anesthesia.

We numb up the scalp.

We take off a piece of bone after cutting the scalp, open the membrane covering the brain called the dura, and then we allow the patient to wake up more from the sedation.

And then what I did on this particular patient was to use a tiny stimulator, a little probe, and I can stimulate areas of her cortex with her awake and see if the stimulation impairs her ability to speak or understand language.

And quite surprisingly, there was no activity in the corridor that I chose.

Sometimes when we see an area that

is involved with speech that's eloquent, we have to choose a different pathway to get to the underlying vascular problem.

And so that's what we did in this case.

And she talked to us the entire case.

She told us about her daughter, who was very involved in debate.

and all of her successes while we were operating, while I was taking out this vascular malformation under 20 magnification with very special instruments.

I use a laser now, which has a diameter of the fiber optic cable.

The laser tip is 0.5 millimeters.