"It is just mind-blowing," said Dr. David Korones, associate professor of pediatrics, oncology and neurology at the University of Rochester Medical Center in Rochester, N.Y. "You walk into the operating room and see on one side of a sheet a person's brain exposed — it looks just like it does in the movies … and walk around on the other side and you can talk to the person."
While the procedure is termed an awake craniotomy, in reality patients are usually only awake for between 10 and 40 minutes of the procedure. This allows surgeons to "map" areas of the brain near the tumor before they cut to preserve vital areas.
The patient experiences no pain while being awake; though doctors dial down general anesthetic during the time that patients are awake, local anesthetic is still in effect. Plus, the brain itself has no pain receptors.
Central to the use of such an approach, however, is the comfort and sedation of the patient.
"Awake surgery is not always required," said Dr. Jeffrey Cozzens, associate professor of neurosurgery at the Northwestern University Feinberg School of Medicine in Evanston, Ill. "It can increase some risks and decrease other risks. It is very dramatic for TV — Grey's Anatomy, ER, et cetera — but is not always the best for the patient."
Many brain experts agreed that the fact that surgery went forward in the first place in Kennedy's case is already a good sign, as it indicates doctors believe that the potential benefits of the procedure warrant the risks inherent to the operation.
But now, Kennedy will face additional treatment. And while he will be able to take advantage of many of the newer radiation and chemotherapy regimens available, challenges remain.
The radiation treatment that Kennedy will get may bring about side effects including short-term memory loss. Chemotherapy and targeted treatments come with their own complement of potential drawbacks.
"It is not a free ride by any means," Korones noted. But he added that Kennedy's trademark white coif would likely be largely spared by the treatment.
"He would not lose his hair with this drug," he said.
Still, regardless of how well Kennedy's body tolerates these treatments, he will be facing a cancer with a high rate of mortality.
"With surgery his prognosis is better," Cozzens said. "But remember that in individuals his age, despite the best treatment, half of patients are dead in one year."
Audrey Grayson contributed to this report.