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Surgeon Removes Kennedy's Brain Tumor

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The Washington Post

Published: June 3, 2008

Sen. Edward Kennedy was recovering Monday night after undergoing brain surgery to remove a malignant tumor, a risky and delicate procedure that offers the 76-year-old Democratic icon the best chance of extending his survival.

After spending a night in intensive care and then about a week at the hospital, Kennedy plans to return to his home state to undergo the next stage of his treatment: chemotherapy and radiation at Massachusetts General Hospital.

"I feel like a million bucks. I think I'll do that again tomorrow," Kennedy quipped to his wife, Victoria, after the 31/2- hour surgery, said Stephanie Cutter, a family spokeswoman.

The surgery was "successful and accomplished our goals," neurosurgeon Allan H. Friedman, who performed the operation at Duke University Medical Center in Durham, N.C., said in a statement.

Kennedy was partly anesthetized but awake through most of the procedure as surgeons monitored his responses to ensure that no crucial brain tissue was removed. Friedman said he should "experience no permanent neurological effects from the surgery."

No additional details were released about the senator's treatment, condition or prognosis, but experts who were not involved in his care said the decision to undergo surgery indicated he and his doctors had opted for the most aggressive treatment, and the surgeons thought they could safely remove a significant proportion of the tumor.

A successful surgery would be the removal of at least 90 percent of the tumor without major neurological damage, several experts said.

"If you didn't do the surgery, you're looking at a much shorter survival period - on the order of a matter of months," said Vivek Deshmukh, director neurosurgery at George Washington University Medical Center.

Kennedy found out last month that he has a malignant glioma, a common and often lethal brain tumor, after having a seizure May 17 at his home in Hyannis Port, Mass., on Cape Cod. The tumor is in a part of his brain known as the left parietal lobe, which is involved in aspects of speech, sensation and motor control.

The decision to operate was made Friday, after a meeting in Boston of experts from across the country, said Anthony Coley, a Kennedy aide. The senator flew to Duke over the weekend with his wife; son, Patrick J. Kennedy, a Democratic congressman from Rhode Island; and his sister, Jean Kennedy Smith.

Although the senator's medical team released no details about the procedure, other experts described the typical course it would follow:

After undergoing an MRI brain scan to provide Friedman with a detailed image of the size and location of the tumor, Kennedy would have a small part of the left side of his head shaved and then would be sedated. Friedman would make an incision probably about 4 to 6 inches long to pull back the scalp so he could drill one or more pea-size holes in the skull to insert a second drill bit to cut out a larger piece of bone, probably about 3 inches in diameter. Friedman would then use a scalpel to cut through the dura, the layer of tissue covering the brain.

About half of such operations at Duke are done as an "awake craniotomy," which involves doctors waking the patient by reducing the levels of anesthesia. Doctors then conduct tests to determine the best path to the tumor, methodically stimulating discrete areas of the brain and asking the patient questions to find out, for example, which parts are involved in speaking, recognizing words or feeling pain. That way surgeons know what areas not to cut.

"Every patient is a little different. This enables the surgeon to say 'This is where the speech area is' and 'This is where the motor area is,'" said John H. Sampson, a neurosurgeon who works with Friedman. Because the brain has no nerve endings, the process is painless.

After determining a safe route to the tumor, Friedman would use a high-powered microscope to begin cutting into the brain to locate the cancer and remove as much tumor tissue as possible, usually guided by a computerized system. After as much of the tumor as possible was removed, Friedman would cauterize blood vessels to stop bleeding, which is one of the biggest risks in brain surgery. The skull bone would be replaced and fastened with titanium plates and screws and the scalp stitched back in place.

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