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This is the sound a violin makes when it’s being played by someone who’s having their brain operated on.
这是一个人一边接受大脑手术一边拉小提琴时拉出的琴声。
Yep. This musician is awake and playing her violin in the middle of her own brain surgery.
没错。这位音乐家在接受脑部手术是时候不仅是醒着的，还在拉小提琴！
But why?!
问题是，她为什么要这么做？
This is something called an awake craniotomy—and get ready for some gory details here.
这就是所谓的“清醒开颅手术”，接下来有一些血淋淋的画面，大家系好安全带。
So, say there’s a patient who needs to undergo brain surgery.
我们假设有一个病人需要接受脑部手术。
They’re sedated for the beginning part, where the doctor makes an incision in the patient’s scalp
医生先给他打上镇静剂好切开他的颅骨，
and drills into their skull with specialized tools to remove a section of the bone from their skull.
然后用专业的工具钻进他的头骨把某个部位的骨头取出来。
And then, the patient is brought out of sedation by the anesthesiologist so they can be conscious while the doctor operates on their brain.
接着，麻醉师将他从镇静状态唤醒，让他在医生继续手术的时候保持清醒。
Which apparently doesn’t hurt because the brain doesn’t have any nociceptors,
显然，病人并不会感觉到疼痛，因为我们的大脑部位是没有疼痛感受器的，
or the nerve cell endings that detect pain.
也即没有感受疼痛的神经细胞末梢。
But again, why does the patient need to be awake?
但是，还是有一个问题，病人为什么要醒着？
Well, the doctor can ask the patient questions throughout the surgery,
答案是，这样医生就能在手术的过程中问病人一些问题，
or ask them to perform basic movements to ensure that what the doctor is doing back there isn’t affecting any of the patient’s capabilities,
或让他们做一些基本的动作，确保医生们的手术，
like in areas of the brain that control things like speech or finger movement.
比如对大脑中控制语言或手指活动的区域的手术，没有影响到病人的正常机能。
And turns out, we’ve actually been doing craniotomies since ancient times, you guys.
事实表明，开颅手术古已有之。
The first archeological evidence of purposeful perforations of the skull dates back to the Neolithic period.
考古学证据显示，有目的地给颅骨穿孔的做法可以追溯到新石器时代。
The first written evidence we have of a craniotomy being performed as a surgery is by Hippocrates in the 5th century BCE,
现存首个有关将开颅作为手术实施的书面证据是公元前5世纪希波克拉底留下的，
who produced guidelines for it to be used in the treatment of epilepsy,
他还编写了指南，告诉人们治疗癫痫的时候怎么操作这一手术，
which remained more or less common practice for the next 2,000 years or so.
后来，这一手术逐渐普及开来，变得相对常规，并一直沿用了将近2000年。
The awake craniotomy heyday really began in the 1920s,
清醒开颅手术真正火起来是20世纪20年代时候的事，
and the development of our modern anesthesia medications to be able to
而这项手术能够普及开来，成为如今全世界都在广泛应用的神经外科手术，
put the patient to sleep for the beginning and end of the surgery have been essential, as you can imagine,
现代麻醉药物的研制堪称功不可没，
in making it a widely used neurosurgery technique around the world today.
因为这些药物能让病人在手术开始和结束阶段进入睡眠状态。
Which brings us back to the violin.
这就又把我们带回了小提琴的话题上。
Dagmar Turner is a violinist who was diagnosed with a brain tumor that had to be removed.
达格玛·特纳是一名小提琴家，她被诊断出得了脑瘤，必须将其切除。
But it was in her right frontal lobe,
但肿瘤的位置是在她的右额叶，
smack in the middle of the spot in her brain that controls the coordination in her left arm and hand—
直接长在了控制左臂和左手协调的区域——
which, you know…is what you use to play the violin.
但你也知道，她拉小提琴就要用到左手啊。
To make sure he was keeping these parts of her brain safe,
为了确保手术没有伤到她的这些部位，
the brain surgeon asked Turner to play her instrument while he was operating on her.
手术的医生便让特纳在他手术的时候拉她的小提琴。
How amazing is that?
是不是屌炸了？
But at the same time, it does still seem a little primitive, right?
但这么做好像还是有点儿落后对不对？
I mean, these surgeries can take hours, and the patient has to stay awake the whole time the surgeon is fiddling around in there.
毕竟，手术可能要持续好几个小时，这样一来，岂不是医生在上面刀进刀出的时候，病人就要一直保持清醒？
Like, is this still the best way we currently have to give patients better outcomes if their tumor is in an area near speech and motor centers?!
如果患者的肿瘤位于控制语言和运动的中枢附近，要想得到更好的手术结果，这种办法真的是目前最行之有效的办法了吗？
Well, it’s a little more advanced than that these days,
嗯，现在的技术要稍微先进一点了，
because doctors are able to map brain activity before surgery using something called functional MRIs,
因为医生可以在手术前借助所谓的“功能性核磁共振”获取脑功能映射图像，
which lets them go into surgery with highly specific information about that patient’s individual brain.
从而非常具体地掌握病人大脑的个体特征，有针对性地进行手术。
This is actually what they did for the violinist’s tumor.
事实上，他们在给小提琴手做肿瘤手术的时候就动用了这一技术。
But fMRIs are also not a perfect solution,
不过，fMRI也不是什么无可指摘的办法，
because they don’t get the clearest picture of what’s going on to begin with.
因为，首先，他们并无能获得非常清晰的脑部活动图像。
And plus, the brain can actually shift during surgery.
其次，大脑在手术的过程中是可能发生移动的。
I mean, it is basically just a hunk of really complex jello sliding around in brain juice in there,
我的意思是，大脑本来就是一大块极其复杂，果冻一样在脑液里滑来滑去的东西，
which makes my head feel kinda…
说到这儿，我脑袋都有点儿……呃……
Enter the next step up in brain surgery sophistication: intraoperative MRIs.
下面我们来说脑外科技术的又一突破：术中核磁共振成像。
These are devices in specialized operating suites that let doctors take real-time MRIs during the brain surgery.
这些安装在专用手术室中的术中核磁共振成像设备能够帮助医生开展脑部手术的时候获取实时的核磁共振图像。
They can basically stop at certain intervals to see what’s going on with the brain during the procedure.
医生们基本可以每隔一段时间就暂停手术，看看手术过程中患者大脑是否无恙。
Surgeons use it to help them tell the difference between the tumor and healthy brain tissue,
医生们也会用这一设备帮助他们区分肿瘤与健康的脑组织，
and to make sure they’re getting all the edges of the bad stuff that needs to be removed.
确保需要摘除的坏死组织的边缘都有得到处理。
But can we get even better?
问题是，（这方面的技术）还有提升空间吗？
Some doctors think so, and are making strides with even more advanced brain mapping techniques.
一些医生认为是有的，他们甚至已经在这方面取得了长足的进步，研制出了更加先进的脑功能映射技术。
One of those involves placing a grid of sensors directly on the brain.
其中一种就是直接给大脑连上一堆探测传感器。
These sensors detect and measure electrical signals
这些传感器检测并测量到电信号以后，
and then the accompanying computer program puts it all together to give the surgeons a digital map of the brain they’re working on.
计算机程序端将所有的电信号整合成医生正在手术的大脑的数字映射图像。
And now we’re using robotics involved in neurosurgery, you guys.
接下来，伙计们，神经外科机器人要登场了！
Robots are helping brain surgeons give patients better outcomes in all kinds of ways,
在帮助脑外科医生更好地救治病人方面，机器人的用处可真太大了，
including a robot that can operate inside an MRI machine,
比如，我们可以把它们内置到核磁共振机内，
which would give the robot—and the doctor—a real-time look at what’s going on in the brain
让它——也让医生——在对病人脑组织开展极其精细的手术时，
as they perform incredibly delicate manipulations of brain tissue.
实时查看病人脑部的情况。
Brain surgery is gettin’ even more complicated—but also better.
如今，脑外科手术越来越复杂了——但技术也越来越好了。
Awake craniotomy has been used for thousands of years for a reason,
清醒开颅手术能一直沿用好几千年是有原因的，
and it’s because it does a pretty good job of making sure that brain surgery goes as smoothly as possible.
原因就是，这种手术能够很好地确保手术尽可能的顺利。
And brain surgeons are looking to use it,
在寻求更好地治疗癫痫和帕金森氏症等疾病的道路上，
and the accompanying advancements that make it even more precise and even more safe,
脑外科医生们也比较倾向于采用这种手术，
to find better treatments for conditions like epilepsy and Parkinson’s disease.
拥抱相应的，让这项手术变得更加精确，更加安全的技术突破。
And there’s good news from the violinist!
另外，小提琴家也有好消息要告诉大家！
Doctors removed over 90% of her tumor, and all of the especially aggressive areas,
尽管医生切除了她90%以上的肿瘤，还有所有扩散性特别强的区域，
and she still has total function of her left hand.
她左手的机能却并没有受到丝毫影响！
So, Turner will be playing the violin for a long time to come.
所以，接下来很长一段时间，特纳都能像往常一样继续拉小提琴。
If you guys found those tidbits of science history cool, then, I got the show for you.
如果你们觉得科学史的这种花边新闻很有意思，哈，你猜怎么着，我已经给大家准备好了一个新节目。
Go listen to Surprisingly Brilliant, my new podcast with Seeker,
我和Seeker合作了一个新栏目Surprisingly Brilliant，
all about the wonderful and weird unknown stories that have shaped science throughout history!
讲的都是历史上对科学产生了重大影响的一些奇妙却又不为人知的故事噢。
You can find it at the link in the description, on iHeart Radio, on Apple podcasts,
大家可以在下面的视频简介里找到链接，也可以到iHeart Radio或苹果的podcasts，
or literally anywhere else podcasts live.
或是其他任何播客平台收听噢。
Keep coming back to Seeker for all of your breaking medical tech news, and thanks for watching.
欢迎大家继续收看Seeker有关突破性医疗技术的新闻，感谢大家的收看。
I'll see ya next time.
我们下期节目再见。
