Translator: eric vautier Reviewer: Cristina Bufi-Pöcksteiner
(Applause)
Eric Fournier: And now,
I invite you to take a deep breath,
and then to chase look very far from your lungs.
And while this is happening,
I suggest you sit back,
and maybe –
you can install even more comfortable,
or maybe not, I do not know.
(Applause)
Ilyess Zemmoura:
Eric is trying to hypnotize our patient,
I await the green light to start to operate.
I neurosurgeon specializing in surgery of brain tumors,
and Eric anesthetist in neurosurgery.
Together we work for brain tumors, under hypnosis.
Before, when I heard of hypnosis,
I imagined a form of esoteric or hypnosis show,
or alternative medicine.
And then I learned that hypnosis
it was a recognized technique, taught,
and used in many fields of medicine.
Today we will explain how hypnosis can help
awake surgery for brain tumors.
Yes, you understand:
our patients are awake when operating the open skull.
Waking the patient after opening the skull,
allows for what is called a mapping of the brain.
For the outstanding feature of the brain is that it is plastic.
With this plasticity can be tolerated, sometimes for years,
the presence of a tumor.
For a tumor when she grows slowly
it will force the brain to modify its operation.
That’s what we call plasticity,
it is the brain’s ability to adapt, reorganize.
In our case, imagine
that an area of the brain, which usually is not used,
will take over the area of the brain that is sick.
That is good news.
The bad news is that it complicates the surgery.
There is no way of knowing, before operating,
how the brain is reorganized.
It was hoped a lot with new techniques
as functional MRI and tractography.
It’s beautiful pictures, it helps science and research,
but it is not reliable enough to be used
on an individual patient for surgery.
In fact, the best way to do is to wake the patient
and to do work for which the operates.
The awake surgery, this is not new.
In 1937
Wilder Penfield, an American neurosurgeon, had described the method:
he used a small electric current to stimulate the brain directly.
If, since 1937,
surgery and anesthesia have made much progress,
it still uses the same small electrical current to understand what is
part of the brain that is being stimulated.
I reassure you right away,
it is not our practice to torture our patients.
If we can do all that, it is because there is no pain,
no feeling either, when it affects the brain.
The other notable feature is that the brain is the only organ
to not have pain receptors.
In fact, only the skin of the scalp and meninges,
the lining of the brain that are located just beneath the skull,
feel pain.
We can fully open the skull under local anesthesia.
This is done regularly for small gestures,
as evacuate some bruising,
or to what is called a biopsy, a sample in the needle,
to go for the diagnosis of a tumor.
EF: And as Ilyess said, the open skull surgery is not painful,
but to open the skull is not necessarily pleasant,
and then when we saw the skull, it is noisy,
it vibrates and it can be perceived as a trauma.
(Laughter)
The technique of awake surgery
usually involves the patient asleep
under general anesthesia to open the skull,
and awaken to work with.
In Tours, as elsewhere,
we had some disappointments with this technique:
Wake agitated, confused, breathing disorders.
I remember the patient who made a spasm of the bronchi
the induction of anesthesia,
Also this patient to the agitated alarm clock, it took control
to prevent it from falling to the operating table.
These reactions are common,
commonplace with general anesthesia,
but for waking surgery, we absolutely need a patient
100% capacity, 100% of its resources and, upon awakening.
The risk of bad alarm clock is a reason
awake surgery, although common, common,
is not systematically practiced.
That is why, in Tours,
we sought an alternative technique.
IZ: Today
all agree that the best way to operate on patients
that have a very specific type of tumors, which are called gliomas,
is to wake them up.
You understood, awake surgery with local anesthesia alone,
it does not suit us.
And awake surgery after general anesthesia, sometimes it is not ideal.
In 2010, Eric came to our service.
We knew he was practicing hypnosis to block for minor surgery.
This is how Stéphane Velut –
– who is here – who is head of Towers of neurosurgery,
had the idea to offer –
to ask Eric if he was able to use hypnosis for this surgery.
And in 2010 in Tours, Eric was the first in the world
to use hypnosis for surgery awake brain tumor.
On September 22, at 9 pm 30 am,
Matthew, 34, made a first seizure.
Once the crisis is over, he went to the emergency.
The same day, he had an MRI of the brain,
and the MRI showed a lesion.
We told him about cyst, mass,
the emergency was given anti-seizure treatment and an appointment with me.
Four days later, Matthew was in my counseling office.
It was not an easy consultation.
He was accompanied by his wife and their two months of last little girl
the big four, she is at school.
They will hear for the first time the tumor word, the word cancer.
It’s also my job to announce this kind of diagnosis,
and that’s not the fun part.
Once the emotion of the past diagnosis, we must address the issue of treatment.
We must speak of waking surgery.
And there it is enough to say they understand why awake surgery.
As I will need active participation during surgery,
I, even more than for other types of surgery, need it accepts.
I want to make sure he has everything to gain by accepting.
I make drawings,
looking at the MRI both to understand the tumor.
It is invasive, it is in the brain.
So when I’m going to operate,
I will not remove a ball from the brain,
I will remove some of his sick brain.
That’s why I need it to be awake, with all its resources,
because, during the operation, we will test live
language,
traction,
attention,
and other functions.
So during this consultation,
it addresses technical issues, surgical,
and more general questions concerning the disease:
We will talk about chronic disease,
Matthew and there begins to understand
it will take him to make the mourning of life before,
life when we did not think the disease.
We do not mourn in an hour, or even in a month,
but do not let too much time,
because the prospect of surgery is stressful,
and you can not really take her life
once the surgery behind.
EF: So a month later, Matthew returns.
He has not yet accepted hypnosis for her surgery;
he comes to understand.
He has an appointment with the therapist – who is also in the room tonight –
preparing the tests that will happen during the procedure.
Then I see in consultation – this is our first meeting –
I make it a classic anesthesia consultation
I then asked about his hobbies,
his favorite colour,
its places of relaxation, his last vacation,
and then his best memories.
Then I hypnotizes.
Matthew looks a point that I drew on one of his wrists.
His eyes close,
and I notice the rapid movements of the eyeballs
behind closed eyelids.
Matthew was in a trance;
his mind went to a place of relaxation.
No matter what, it is guided by his subconscious.
This first hypnotic experience will allow Matthew
to choose whether surgery will be done under hypnosis or not.
Confidence is gradually
between Matthew and our team of professionals.
Finally, Matthew agrees hypnosis for her surgery.
On 15 November, in the morning,
Matthew is conducted in the operating room, room 12, neurosurgery.
At the sound of my voice, the voice that accompanies it,
Matthew gradually between hypnotic trance.
It is prepared,
is placed an infusion, a urinary catheter,
then spiked headrest.
Then complete Ilyess local anesthesia scalp.
Still in his voice that accompanies it,
Matthew plays with her favorite color.
She entered the body through its bottom,
then queue along the spine to invade the whole head,
which becomes much lighter than the rest of the body.
I then asked Matthew to ride a bicycle,
an odd bicycle wheel with a square, a triangular wheel.
He pedal, pedal it, it pedal while the whole body vibrates.
The open cranium
I invite Matthew to return here and now,
out of his trance.
It is quiet, relaxed and can make optimal testing.
Ilyess and speech therapist
can now establish the mapping of the brain.
IZ: And the tests will be linked together for the duration of the intervention.
On the surface, while I do the mapping,
but everything while I remove the tumor.
It’s like a small marathon, 1h 30 to 2h, without pause,
during which we are all fully aware, as Matthew,
concentrated and focused to the end.
It’s tiring,
but it is so important to the success of the surgery,
and for life after Matthew.
Nowadays,
we operated under hypnosis 57 patients
as Matthew, who were suffering from a brain tumor.
EF: And how does hypnosis work?
Me, I do not know,
and no one can tell you exactly, precisely,
how hypnosis works,
but it works.
It is noted that, during the hypnotic process,
the patient out of the real,
he dissociated:
the body is here, the mind is elsewhere.
And during the hypnotic trance,
patients change reality orientation.
It focuses on his inner experience,
and then put in brackets
the elements of the outside world, which are not relevant.
It is also said that, when you put a patient under hypnosis,
the left brain is inhibited,
the brain of the world of reality,
to promote the right brain,
the brain of the world of imagination,
but this remains a theoretical and currently
researchers working on brain function
when under hypnosis.
But does it always work?
Always ? No.
Most of the time ? Yes.
For we are more or less sensitive to the suggestions of the hypnotist.
We are more or less receptive to hypnosis.
During a work,
we recently published in a scientific journal,
we showed
six of our patients did not respond to hypnosis.
We have fallen asleep with general anesthesia,
then woke up without any particular consequence.
But the low failure rate among our patients –
representing 10% in our series against 25% in the general population –
can be explained by an increased susceptibility to hypnosis
related special events.
Indeed, our patients are motivated,
they are still very motivated, they are active and involved in the care,
because they understand that we absolutely need them
to carry out this surgery.
The disease broke into their lives,
but they, in response, they take care of the technology.
IZ: Hypnosis for awake surgery for brain tumors,
possible, it works.
By taking the time,
explaining to our patients why and how the treatment is taking place,
creating trust,
accept this adventure becomes almost obvious, for our patients.
although it is known to be a source of stress,
but it is also a mark of responsibility,
and it is the art of the doctor today
to succeed in putting the patient at the center of its management,
without burdening him too heavy medical liability.
Guide our patients, encourage,
accompany them,
showing them that we have confidence in their ability to live this experience.
This is how our patients, these men, these women,
who come to our department for surgery of the brain,
to fight a tumor, sometimes cancerous,
understand that they are able to do something extraordinary.
Thank you.
(Applause)
(Applause)
Eric Fournier: And now,
I invite you to take a deep breath,
and then to chase look very far from your lungs.
And while this is happening,
I suggest you sit back,
and maybe –
you can install even more comfortable,
or maybe not, I do not know.
(Applause)
Ilyess Zemmoura:
Eric is trying to hypnotize our patient,
I await the green light to start to operate.
I neurosurgeon specializing in surgery of brain tumors,
and Eric anesthetist in neurosurgery.
Together we work for brain tumors, under hypnosis.
Before, when I heard of hypnosis,
I imagined a form of esoteric or hypnosis show,
or alternative medicine.
And then I learned that hypnosis
it was a recognized technique, taught,
and used in many fields of medicine.
Today we will explain how hypnosis can help
awake surgery for brain tumors.
Yes, you understand:
our patients are awake when operating the open skull.
Waking the patient after opening the skull,
allows for what is called a mapping of the brain.
For the outstanding feature of the brain is that it is plastic.
With this plasticity can be tolerated, sometimes for years,
the presence of a tumor.
For a tumor when she grows slowly
it will force the brain to modify its operation.
That’s what we call plasticity,
it is the brain’s ability to adapt, reorganize.
In our case, imagine
that an area of the brain, which usually is not used,
will take over the area of the brain that is sick.
That is good news.
The bad news is that it complicates the surgery.
There is no way of knowing, before operating,
how the brain is reorganized.
It was hoped a lot with new techniques
as functional MRI and tractography.
It’s beautiful pictures, it helps science and research,
but it is not reliable enough to be used
on an individual patient for surgery.
In fact, the best way to do is to wake the patient
and to do work for which the operates.
The awake surgery, this is not new.
In 1937
Wilder Penfield, an American neurosurgeon, had described the method:
he used a small electric current to stimulate the brain directly.
If, since 1937,
surgery and anesthesia have made much progress,
it still uses the same small electrical current to understand what is
part of the brain that is being stimulated.
I reassure you right away,
it is not our practice to torture our patients.
If we can do all that, it is because there is no pain,
no feeling either, when it affects the brain.
The other notable feature is that the brain is the only organ
to not have pain receptors.
In fact, only the skin of the scalp and meninges,
the lining of the brain that are located just beneath the skull,
feel pain.
We can fully open the skull under local anesthesia.
This is done regularly for small gestures,
as evacuate some bruising,
or to what is called a biopsy, a sample in the needle,
to go for the diagnosis of a tumor.
EF: And as Ilyess said, the open skull surgery is not painful,
but to open the skull is not necessarily pleasant,
and then when we saw the skull, it is noisy,
it vibrates and it can be perceived as a trauma.
(Laughter)
The technique of awake surgery
usually involves the patient asleep
under general anesthesia to open the skull,
and awaken to work with.
In Tours, as elsewhere,
we had some disappointments with this technique:
Wake agitated, confused, breathing disorders.
I remember the patient who made a spasm of the bronchi
the induction of anesthesia,
Also this patient to the agitated alarm clock, it took control
to prevent it from falling to the operating table.
These reactions are common,
commonplace with general anesthesia,
but for waking surgery, we absolutely need a patient
100% capacity, 100% of its resources and, upon awakening.
The risk of bad alarm clock is a reason
awake surgery, although common, common,
is not systematically practiced.
That is why, in Tours,
we sought an alternative technique.
IZ: Today
all agree that the best way to operate on patients
that have a very specific type of tumors, which are called gliomas,
is to wake them up.
You understood, awake surgery with local anesthesia alone,
it does not suit us.
And awake surgery after general anesthesia, sometimes it is not ideal.
In 2010, Eric came to our service.
We knew he was practicing hypnosis to block for minor surgery.
This is how Stéphane Velut –
– who is here – who is head of Towers of neurosurgery,
had the idea to offer –
to ask Eric if he was able to use hypnosis for this surgery.
And in 2010 in Tours, Eric was the first in the world
to use hypnosis for surgery awake brain tumor.
On September 22, at 9 pm 30 am,
Matthew, 34, made a first seizure.
Once the crisis is over, he went to the emergency.
The same day, he had an MRI of the brain,
and the MRI showed a lesion.
We told him about cyst, mass,
the emergency was given anti-seizure treatment and an appointment with me.
Four days later, Matthew was in my counseling office.
It was not an easy consultation.
He was accompanied by his wife and their two months of last little girl
the big four, she is at school.
They will hear for the first time the tumor word, the word cancer.
It’s also my job to announce this kind of diagnosis,
and that’s not the fun part.
Once the emotion of the past diagnosis, we must address the issue of treatment.
We must speak of waking surgery.
And there it is enough to say they understand why awake surgery.
As I will need active participation during surgery,
I, even more than for other types of surgery, need it accepts.
I want to make sure he has everything to gain by accepting.
I make drawings,
looking at the MRI both to understand the tumor.
It is invasive, it is in the brain.
So when I’m going to operate,
I will not remove a ball from the brain,
I will remove some of his sick brain.
That’s why I need it to be awake, with all its resources,
because, during the operation, we will test live
language,
traction,
attention,
and other functions.
So during this consultation,
it addresses technical issues, surgical,
and more general questions concerning the disease:
We will talk about chronic disease,
Matthew and there begins to understand
it will take him to make the mourning of life before,
life when we did not think the disease.
We do not mourn in an hour, or even in a month,
but do not let too much time,
because the prospect of surgery is stressful,
and you can not really take her life
once the surgery behind.
EF: So a month later, Matthew returns.
He has not yet accepted hypnosis for her surgery;
he comes to understand.
He has an appointment with the therapist – who is also in the room tonight –
preparing the tests that will happen during the procedure.
Then I see in consultation – this is our first meeting –
I make it a classic anesthesia consultation
I then asked about his hobbies,
his favorite colour,
its places of relaxation, his last vacation,
and then his best memories.
Then I hypnotizes.
Matthew looks a point that I drew on one of his wrists.
His eyes close,
and I notice the rapid movements of the eyeballs
behind closed eyelids.
Matthew was in a trance;
his mind went to a place of relaxation.
No matter what, it is guided by his subconscious.
This first hypnotic experience will allow Matthew
to choose whether surgery will be done under hypnosis or not.
Confidence is gradually
between Matthew and our team of professionals.
Finally, Matthew agrees hypnosis for her surgery.
On 15 November, in the morning,
Matthew is conducted in the operating room, room 12, neurosurgery.
At the sound of my voice, the voice that accompanies it,
Matthew gradually between hypnotic trance.
It is prepared,
is placed an infusion, a urinary catheter,
then spiked headrest.
Then complete Ilyess local anesthesia scalp.
Still in his voice that accompanies it,
Matthew plays with her favorite color.
She entered the body through its bottom,
then queue along the spine to invade the whole head,
which becomes much lighter than the rest of the body.
I then asked Matthew to ride a bicycle,
an odd bicycle wheel with a square, a triangular wheel.
He pedal, pedal it, it pedal while the whole body vibrates.
The open cranium
I invite Matthew to return here and now,
out of his trance.
It is quiet, relaxed and can make optimal testing.
Ilyess and speech therapist
can now establish the mapping of the brain.
IZ: And the tests will be linked together for the duration of the intervention.
On the surface, while I do the mapping,
but everything while I remove the tumor.
It’s like a small marathon, 1h 30 to 2h, without pause,
during which we are all fully aware, as Matthew,
concentrated and focused to the end.
It’s tiring,
but it is so important to the success of the surgery,
and for life after Matthew.
Nowadays,
we operated under hypnosis 57 patients
as Matthew, who were suffering from a brain tumor.
EF: And how does hypnosis work?
Me, I do not know,
and no one can tell you exactly, precisely,
how hypnosis works,
but it works.
It is noted that, during the hypnotic process,
the patient out of the real,
he dissociated:
the body is here, the mind is elsewhere.
And during the hypnotic trance,
patients change reality orientation.
It focuses on his inner experience,
and then put in brackets
the elements of the outside world, which are not relevant.
It is also said that, when you put a patient under hypnosis,
the left brain is inhibited,
the brain of the world of reality,
to promote the right brain,
the brain of the world of imagination,
but this remains a theoretical and currently
researchers working on brain function
when under hypnosis.
But does it always work?
Always ? No.
Most of the time ? Yes.
For we are more or less sensitive to the suggestions of the hypnotist.
We are more or less receptive to hypnosis.
During a work,
we recently published in a scientific journal,
we showed
six of our patients did not respond to hypnosis.
We have fallen asleep with general anesthesia,
then woke up without any particular consequence.
But the low failure rate among our patients –
representing 10% in our series against 25% in the general population –
can be explained by an increased susceptibility to hypnosis
related special events.
Indeed, our patients are motivated,
they are still very motivated, they are active and involved in the care,
because they understand that we absolutely need them
to carry out this surgery.
The disease broke into their lives,
but they, in response, they take care of the technology.
IZ: Hypnosis for awake surgery for brain tumors,
possible, it works.
By taking the time,
explaining to our patients why and how the treatment is taking place,
creating trust,
accept this adventure becomes almost obvious, for our patients.
although it is known to be a source of stress,
but it is also a mark of responsibility,
and it is the art of the doctor today
to succeed in putting the patient at the center of its management,
without burdening him too heavy medical liability.
Guide our patients, encourage,
accompany them,
showing them that we have confidence in their ability to live this experience.
This is how our patients, these men, these women,
who come to our department for surgery of the brain,
to fight a tumor, sometimes cancerous,
understand that they are able to do something extraordinary.
Thank you.
(Applause)
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