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Kennedy Surgery Called Success

"Every patient is different. We have a bunch of new treatments that are looking pretty good," said Matthew G. Ewend, chief of neurosurgery at the University of North Carolina at Chapel Hill. "You just have to keep fighting year by year."

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 on Friday, after a meeting in Boston of experts from around the country, a Kennedy aide said, speaking on the condition of anonymity. The senator flew to Duke over the weekend with his wife and were joined there by son Patrick J. Kennedy, a Democratic congressman from Rhode Island, and his sister Jean Kennedy Smith, the aide said.

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 four to six 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 three 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,' " Sampson said. Stressing that he was not commenting specifically on Kennedy, he added that such operations are usually performed on patients whose tumors are in sensitive locations.

Because the brain has no nerve endings, the process is painless.

"It's not a painful, frightening thing," said Sampson, noting that patients have no memory of the experience.

After determining a safe route to the tumor, Friedman would use a high-powered microscope to begin painstakingly cutting into the brain to locate the cancer and remove tumor tissue, usually guided by a computerized system. "It's sort of like a GPS system for neurosurgeons," Ewend said.

The cancerous tissue can be excised with several devices, but Duke surgeons usually use a "bipolar coagulator," which uses heat to cut and coagulate the cancerous tissue, which is then suctioned out with a small tube, Sampson said. A tiny, scissors-like scalpel is used to cut blood vessels.

After removing as much of the tumor as possible, Friedman would cauterize blood vessels to stop bleeding, which is one of the biggest risks in brain surgery. Some surgeons also apply a foam-like substance that promotes clotting. In some cases, wafers containing chemotherapy drugs may be left at the site, Sampson said.

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