Olive-stuffing and in-theatre piano: the brain surgeon breaking new ground

By Angela Giuffrida

Playing the violin, watching cartoons and doing crosswords: these are just some of the activities patients have performed while having brain surgery under Roberto Trignani.

Trignani, the head of neurosurgery at Riuniti hospital in Ancona, Italy, was already known for his “awake surgery” techniques, which he has used roughly 70 times in the last few years. But he broke new ground in June this year when a 60-year-old woman prepared stuffed olives as he removed a tumour from her left temporal lobe.

It was no easy feat – the preparing of the olives, that is. Known as Ascoli olives, a speciality of the Marche region, they are prepared in a complex process in which green olives are pitted then wrapped with cured meat, coated with breadcrumbs and fried. The woman, a former chef, made 90 of them in less than an hour.

Meanwhile, Trignani operated. Awake surgery allows the surgeon to avoid damaging healthy tissue while treating areas of the brain responsible for speech, vision and movement. In the case of the olive-maker, Trignani and his team were able to remove the tumour from an area of the brain that controls speech as well as the right side of the body.

“We studied the patient’s life, her routines and preferred activities to see if there was anything that could be useful to her therapeutic course,” Trignani told the Guardian. “In this case, the woman was a good cook and, above all, had worked in an area known for Ascoli olives. We knew that in order to prepare such olives you need significant manual skill, and so we thought that getting her to make the olives would be a way to monitor the area of the brain we needed to work on.”

The operation went according to plan, and the woman, who left hospital after a few days, has been recovering well.

Trignani’s unorthodox ideas are not limited to conscious surgery. One brainwave came to him this summer after he attended a concert by Emiliano Toso, a musician and molecular biologist who claims to play music at a soothing frequency. “While listening to his music, I thought: what would happen if we brought Emiliano Toso’s grand piano into the operating theatre?’” Trignani said.

Toso agreed to play, and in November a piano was brought into the operating theatre for a four-hour operation to remove a tumour from a 10-year-old boy’s spinal chord. Although the patient was under general anaesthetic, Trignani said the encephalogram, which monitors electrical activity of the brain, suggested the boy was perceiving the music. When the musical notes were interrupted, he said, the brain’s patterns changed.

Another of Trignani’s cutting-edge surgeries was on a woman who was blind in one eye and had developed a tumour in an area of the brain that controlled vision in her other eye. The operation took place last year on 13 December, the feast day of Santa Lucia or “the festival of light” in Italy. As Trignani operated to remove the tumour, the woman took eye tests on a computer screen.

“If we’d had damaged the area close to the healthy eye she would have become blind,” said Trignani. “So we decided to do awake surgery for her too – there have only been about five or six cases of this kind in the world. She wrote to me a few days ago, as 13 December [2020] approached, saying Santa Lucia had protected her as she still sees well in that eye.”

Trignani said the most satisfying part of his role in awake surgeries was the human connection during the operations, and the patient’s response afterwards. “When you see a patient doing good and they have a sense of gratitude, this is the most beautiful part,” he said. “Those who become doctors do so as they want to see patients doing well – this mission makes you want to eradicate human suffering.”