Parkinson's Patient Wide Awake During Procedure

By GINA STAFFORD

943 words

2 July 1999

11:04 AM

Associated Press Newswires

APRS

English

(c) 1999. The Associated Press. All Rights Reserved.

KNOXVILLE, Tenn. (AP) - Surgically treating Walter "Al" Floyd's tremor caused by Parkinson's disease took the skills of a neurosurgeon using some of medicine's most high-tech tools with the precision of a diamond cutter.

It also required the patient's help. Floyd had to be awake while Dr. Richard Boyer inserted a probe deep in his brain.

After almost five hours of searching for the optimal response, Boyer knew he'd found it when Floyd extended a steady arm on command. It was a sight the awed patient had waited years to see.

"Doc, you've just done a miracle," Floyd said tearfully from the operating table. "How's it feel to do miracles for a living?"

"We just appreciate your patience," Boyer answered.

Brain surgery on awake patients is not common.

Floyd has been awake through two. First on March 3, when Boyer implanted a pacemaker-sized battery and electrodes to treat Parkinson's disease tremor on Floyd's right side. On June 4, Floyd underwent the same procedure to treat his left side.Getting prepped

Floyd arrived at Fort Sanders Regional Medical Center at 5:30 a.m. While the patient was off getting prepped for the operation, his brother, Frank Floyd, and mother, Sandy Floyd, both of Knoxville, joined others sipping coffee in a waiting room.

When Boyer arrived, it was time to put a stereotactic frame, or "halo," on Floyd's head. Boyer put lidocaine-soaked cotton in Floyd's ears, then screwed pins into the patient's ear canals.

"All right, this is the part you hate," Boyer cautioned while reaching for a syringe.

"Just tell me when it's about to happen," Floyd said. His eyelids clenched shut and his brow knotted as lidocaine shots were injected into his forehead. The shots numb the sites where pointed bolts will make little more than a pinprick in the skin on their way to being screwed just into the skullbone.

Floyd says the shots are the worst part, the only really painful part, of what will end up to be an almost 10-hour day with Boyer.Let the surgery begin

With the frame secure at 7:45 a.m., Floyd and his medical entourage crossed over to the Thompson Cancer Survival Center. There, he underwent a brain MRI that served as something of a map for the operation.

When the actual surgery was about to begin two hours later, innocuous-looking speakers were echoing the pop song "Livin' La Vida Loca" off the chilly operating room walls. Undistracted, Boyer explained that because the "brain is fairly symmetrical, (the operation) shouldn't be that different" from Floyd's prior one.

Guided by metric markings on the "halo" and coordinates derived with help from the MRI, Boyer marked the incision site on Floyd's scalp with a 2-inch line crossed by a half-inch line.

The incision and all other preparations made, Boyer told Floyd it was time for a 14-millimeter hole to be drilled through his skull. Neither bone nor the brain are sensitive to touch.

"Let's rock and roll," Floyd said.

In about 30 seconds, the hole was bored and a circular plastic seat was fitted into its edge. A catheter guided the probe to a spot about 4 inches deep in Floyd's brain.

"When I was in general surgery, I hated it," Boyer said. "I thought it was boring."

The first attempt to place the probe didn't satisfy the doctor. Because Floyd either still showed some tremor or reported some "tingling," Boyer made five more attempts.

Removing the probe, the catheter and a gadget that holds both onto the frame was a painstakingly tedious task that took roughly 15 minutes each time.

All for a new location just 1.5 to 2 millimeters away. Picture an ordinary small paper clip; the width of its wire is roughly the distance the probe is moved when another location is used, Boyer said.Feeling some fear

Once electric current was delivered, Floyd was asked to raise his usually shaky left hand into the air. Each time it still shook, Boyer paced, arms folded, brow knitted, pondering. Variously during the afternoon, Floyd also reported tingling. In his left arm, left leg, cheeks, the corner of his mouth. Or muscle tightness. Even fear.

"I have, kind of ... something hard to describe," Floyd once said. "It's like, I'm feeling a little paranoid."

After the operation, Boyer explained that the reaction was expected.

"We have an idea of the depth of the target, but every once in a while we may advance the electrode a little deeper to help map things out," Boyer said. "It helps to get into that sensory part of the thalamus, and we did advance the electrode a little deeper, which resulted in him having the fear."

After Boyer made his sixth pass, Floyd finally raised a steady left arm. Then he easily put his left hand to his chin and back out again. He was handed a coffee mug, which he used to simulate the motions of drinking.

"I can't wait to get an automobile," Floyd said. "I won't go home except to sleep."

The reaction brought Boyer a much-appreciated moment.

"That's one of the most satisfying feelings in neurosurgery," he said. "To see the tremor go away and see the response of the patient, some of the emotion they experience, and how they can't believe how this is now changed them. That's pretty powerful."

AP Photo TNKNN101 of July 2

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