This Music Teacher Played His Saxophone While In Brain Surgery

Aug 25, 2017
Originally published on August 25, 2017 10:47 pm

Dan Fabbio was 25 and working on a master's degree in music education when he stopped being able to hear music in stereo. Music no longer felt the same to him.

When he was diagnosed with a brain tumor, he immediately worried about cancer. Fortunately, his tumor was benign. Unfortunately, it was located in a part of the brain known to be active when people listen to and make music.

Fabbio told his surgeon that music was the most important thing is his life. It was his passion as well as his profession.

His surgeon understood. He's someone whose passion has been mapping the brain so he can help patients retain as much function as possible.

Dr. Web Pilcher, chair of the Department of Neurosurgery at the University of Rochester Medical Center, and his colleague Brad Mahon, a cognitive neuroscientist, had developed a brain mapping program. Since 2011, they've used the program to treat all kinds of patients with brain tumors: mathematicians, lawyers, a bus driver, a furniture maker. Fabbio was their first musician.

The idea behind the program is to learn as much as possible about the patient's life and the patient's brain before surgery to minimize damage to it during the procedure.

"Removing a tumor from the brain can have significant consequences depending upon its location," Pilcher says. "Both the tumor itself and the operation to remove it can damage tissue and disrupt communication between different parts of the brain."

Ahead of Fabbio's surgery, it was important to understand exactly what parts of his brain were responsible for his musical abilities. The team spent six months studying the functional and structural organization of Fabbio's brain, Mahon tells All Things Considered host Robert Siegel.

"We have a lot of experience mapping language in the left hemisphere," Mahon says. "This was the first time we sought to map music ... in the right hemisphere."

Working with Elizabeth Marvin, a professor of music theory with the University of Rochester's Eastman School of Music, Mahon came up with a series of music tests for Fabbio.

They asked him to listen to piano melodies and hum them back while he underwent functional MRI scans. In between melodies, he listened to and repeated spoken sentences. The scans allowed the researchers to pinpoint the areas of Fabbio's brain that are crucial for music and language processing. From those scans, they produced a three-dimensional map of Fabbio's brain.

That map was a guide for Pilcher and his medical team during the surgery in July 2016. Fabbio was not only awake, but he once again performed the music and language tests, this time with his brain exposed. Marvin, who was in the operating room, scored those tests in real-time, helping the surgeons identify which areas to avoid.

Once his tumor was removed, Fabbio was given his saxophone. Lying on his side, he played a song he'd prepared for that moment. Out of concern that the deep breaths required for long notes could cause his brain to protrude from his skull, Fabbio and Marvin had chosen a Korean folk song and modified it so he could use shorter, shallower breaths.

"He played it flawlessly, and when he finished, the entire operating room erupted in applause," says Marvin. "It made you want to cry."

As a musician, Fabbio had long had a remarkable talent: As he brushed his teeth with an electric toothbrush, he would hear in his head melodies that harmonized with the hum of the toothbrush. But that stopped happening when his tumor showed up.

Then one day, about a month after his brain surgery, Fabbio was brushing his teeth and suddenly, the harmonies returned.

"He realized at that point that his brain had recovered completely," Pilcher says.

Fabbio's case is described in detail in a study published Thursday in the journal Current Biology.

Justine Kenin, a producer for All Things Considered, contributed to this story.

Copyright 2017 NPR. To see more, visit http://www.npr.org/.

ROBERT SIEGEL, HOST:

Imagine that you're a musician.

(SOUNDBITE OF SAXOPHONE MUSIC)

SIEGEL: And imagine that you discover you have a brain tumor right near the part of your brain that's key to playing your instrument. Well, there's a team of doctors and researchers specializing in this kind of surgery. But there's a catch. They may want you to play your instrument during the operation. With us to explain this is Dr. Web Pilcher and Brad Mahon, who's one of the authors of a new study in Current Biology. Welcome to both of you.

BRAD MAHON: Thank you, Robert.

WEB PILCHER: Thank you.

SIEGEL: And that bit of saxophone we heard just now was Dan Fabbio onstage. He had a tumor. The two of you are in Rochester, N.Y., and you were both involved in removing it. First, how long did it take to prep for the surgery? And what did all this involve? Dr. Pilcher?

PILCHER: I think all of this began early before the diagnosis, when this young musician was listening to music and he found that the music, instead of having three-dimensional structure, went from being stereo to mono. Music did not have the same feel. It was almost like he was experiencing an alternate reality. All of that led to an MRI scan. The MRI scan demonstrated a tumor.

And Dr. Mahon and I have put a team together over the years where we have become very expert at mapping spoken language in lawyers, in doctors, in bus drivers and every patient who has a tumor in the spoken language area of the brain. But this tumor was in an area of the brain that has not been studied carefully. And very few awake surgeries have been done where mapping has been employed to try to preserve music function. And so that set the stage for the operation.

SIEGEL: Brad Mahon?

MAHON: So we spent about six months studying Dan. And we did this using various types of MRI to study the functional organization of his brain. And we also studied the structural organization of his brain. And we also partnered with the Eastman School of Music and Dr. Betsy Marvin to develop a series of tasks that could be used during his surgery.

SIEGEL: So this is awake surgery. And that, I gather - that's not that unusual in terms of brain surgery. But what is unusual is asking the patient to play the saxophone during the surgery, which we have a little bit of sound you recorded. Here it is.

(SOUNDBITE OF SAXOPHONE MUSIC)

SIEGEL: What were you looking for, and what did you find?

PILCHER: If you can imagine yourself lying on your side with the right side of your skull opened and the brain exposed and trying to breathe carefully so that the brain would not protrude out of the skull, that was the condition that Dan Fabbio was in when he played those notes. And he played those notes at the end of the tumor resection, when we knew we were peeling the last fragments of tumor off of the thin strip of brain cortex that was responsible for his music.

(SOUNDBITE OF ARCHIVED RECORDING)

DAN FABBIO: (Playing saxophone).

UNIDENTIFIED WOMAN: Perfect.

SIEGEL: And so Brad Mahon, what did you learn? What were you seeing going on in Mr. Fabbio's brain as he was playing the saxophone during surgery?

MAHON: Dr. Pilcher had been stimulating Dan's brain while he had been performing a melody repetition task or a sentence repetition task. And music and language interestingly seem to occupy similar regions across the two hemispheres. So there are very prescribed regions in the left hemisphere in most individuals that support language abilities, and pretty much the same regions in the right hemisphere seem to be involved in music abilities.

SIEGEL: Well, back to our saxophonist, Dan Fabbio. Is he doing OK? And does he hear the difference between stereophonic music and mono music? Can he distinguish musical sounds as well as he could before the tumor?

PILCHER: What he described after his surgery for about a month was that music remained monophonic. And in fact, one example he gave was that every day, when he would brush his teeth with an electric toothbrush, he would hear harmonies and pitches in the sound of the electric toothbrush and his brain almost subconsciously would create melodies that would harmonize with the toothbrush. And he noticed for the first few weeks after his surgery that this didn't happen. None of these spontaneous musical events occurred. And one day he was brushing his teeth and suddenly it was back to normal. He heard the harmonics in the toothbrush. And he realized at that point that his brain had recovered completely.

SIEGEL: That's (laughter) - that's an amazing - an amazing landmark of recovery that you've just described, when the music returns to your toothbrush. Dr. Brad Mahon and Dr. Web Pilcher, both of the University of Rochester Medical Center. Thanks for talking with us about this.

MAHON: Thank you, Robert.

PILCHER: Thank you. Transcript provided by NPR, Copyright NPR.