(Applause)
Eric Fournier: And now,
I invite you to take a deep breath,
and then, to chase the air very far from your lungs.
And while this is happening,
I propose you to sit comfortably,
and maybe –
you can sit even more comfortable,
or maybe not, I do not know.
(Applause)
Ilyess Zemmoura:
Eric is hypnotizing our patient,
I’m waiting for the green light to start operating it.
I am a neurosurgeon, specialized in surgery for brain tumors,
and Eric is anesthetist-resuscitator in neurosurgery.
Together, we operate brain tumors under hypnosis.
Before, when I heard about hypnosis,
I imagined a form of esotericism or spectacle hypnosis,
or a parallel medicine.
And then, I learned that hypnosis,
it was a recognized technique, taught,
and used in many fields in medicine.
Today we will explain how hypnosis can help
awake surgery of brain tumors.
Yes, you understand well:
our patients are awake when operated with an open skull.
Wake the patient once the skull is open,
lets do what is called a map of his brain.
Because the remarkable characteristic of the brain is that it is plastic.
Thanks to this plasticity, we can tolerate, sometimes for years,
the presence of a tumor.
Because a tumor, when it grows slowly,
it will force the brain to change its functioning.
That’s what we call plasticity,
it is the capacity of the brain to adapt, to reorganize itself.
In our case, you have to imagine
that an area of the brain, which usually is not used,
will take over from 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 has reorganized itself.
We were hoping a lot with the new techniques
such as functional MRI or tractography.
It makes beautiful pictures, it helps science and research,
but it’s not reliable enough to use
on a given patient, for surgery.
In fact, the best way to do this is to wake up the patient
and to make it work while it is being done.
The waking surgery is not new.
In 1937,
Wilder Penfield, an American neurosurgeon, described the method:
he used a small electric current to stimulate the brain directly.
If, since 1937,
surgery and anesthesia have made a lot of progress,
we always use the same little electric current to understand what’s the point
the 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’s because there’s no pain,
no feeling either, when you touch the brain.
The other remarkable feature of the brain is that it is the only organ
to have no pain receptors.
In fact, only the skin of the scalp and the meninges,
the brain envelopes that are located just under the skull,
feel the pain.
We can perfectly open the skull under local anesthesia.
We do it regularly for small gestures,
as evacuate some hematomas,
or do what’s called a biopsy, a needle sampling,
to go to the diagnosis of a tumor.
EF: And as Ilyess says, open skull surgery is not painful,
but having your skull open is not necessarily pleasant,
and then when you saw the cranial box, it’s noisy,
it vibrates and it can be perceived as a trauma.
(Laughter)
The awakened surgery technique
is usually to lull the patient to sleep
under general anesthesia to open the cranial box,
and to wake him up to work with.
In Tours, as elsewhere,
we had some disappointments with this technique:
waking, confused awakenings, respiratory troubles.
I remember this patient who had a bronchial spasm
at induction of anesthesia,
also from this patient to the restless awakening, which had to be mastered
to prevent it from falling off the operating table.
These reactions are common,
commonplace with general anesthesia,
but for waking surgery, we absolutely need a patient
to 100% of its capacities, to 100% of its means and this, from the awakening.
The risk of bad waking is one reason
awake surgery, although common, common,
not be practiced systematically.
That’s why, in Tours,
we looked for an alternative technique.
IZ: Today,
all agree that the best way to operate patients
who have a very particular type of tumors, which are called gliomas,
it’s to wake them up.
You have understood, awake surgery with local anesthesia alone,
it did not suit us.
And waking surgery after general anesthesia, sometimes it’s not ideal.
In 2010, Eric arrived in our service.
He was known to practice hypnosis in the block for minor surgery.
That’s how Stéphane Velut –
– who is here – who is head of the neurosurgery department of Tours,
had the idea to propose –
to ask Eric if he felt able to use hypnosis for this surgery.
And, in 2010, in Tours, Eric was the first in the world
to use hypnosis for awake surgery of a brain tumor.
On September 22, at 9:30 am,
Matthieu, 34, has had a first epileptic seizure.
Once the crisis passed, he went to the emergency room.
The same day, he had an MRI of the brain,
and this MRI showed a lesion.
He was told about a cyst, a mass,
the emergency doctor gave him an anti-epileptic treatment and an appointment with me.
Four days later, Matthew was in my consulting office.
It was not an easy consultation.
He was accompanied by his wife and their last two-month-old daughter
the big one is four, she is at school.
They will hear for the first time the word tumor, the word cancer.
It’s also my job to announce this kind of diagnosis,
and it’s not the most enjoyable part.
Once the emotion of the diagnosis has passed, we must address the issue of treatment.
We must talk about waking surgery.
And there, enough must be said for him to understand why an awake surgery.
As I will need his active participation during the surgery,
I have, even more than for other types of surgeries, need that he accepts.
I want him to be convinced that he has everything to gain by accepting.
I make drawings,
we look at the MRI both to understand the tumor.
She’s infiltrating, she’s in the brain.
And so, when I’m going to operate it,
I will not remove a brain ball,
I’m going to remove some of his sick brain.
That’s why I need him to be awake, having all his means,
because, during the intervention, we will test live
language,
traction,
attention,
and other functions.
So during this consultation,
we tackle technical, surgical,
and more general questions about the disease:
We will talk about chronic illness,
and there Matthew begins to understand
that he will have to mourn the life before,
life where we did not think about illness.
We do not mourn in an hour, or even a month,
but do not let too much time go by,
because the perspective of surgery is stressful,
and we can not really get back to life
only once the surgery is behind you.
EF: Then, a month later, Matthew returns.
He has not yet accepted hypnosis for his surgery;
he comes to understand.
He has an appointment with the speech therapist – who is also in the room tonight –
who prepares him for the tests he will pass during the procedure.
Then, I see him in consultation – this is our first meeting –
I give him a consultation of classical anesthesia,
then I ask him about his hobbies,
his favorite colour,
its places of relaxation, its last holidays,
and then his best memories.
Then I hypnotize him.
Matthew looks at a point I drew on one of his wrists.
His eyes close,
and I notice quick movements of the eyeballs
behind closed eyelids.
Matthew is in a trance;
his mind is gone in a place of relaxation.
No matter what place, he is guided by his unconscious.
This first hypnotic experience will allow Matthieu
to choose whether the surgery will be done under hypnosis or not.
Confidence gradually settles
between Matthew and our team of practitioners.
Finally, Matthew accepts hypnosis for his surgery.
November 15, early in the morning,
Matthieu is taken to the operating room, room 12, of neurosurgery.
At the sound of my voice, the voice that accompanies it,
Matthew enters gradually into a hypnotic trance.
We prepare it,
we set up an infusion, a urinary catheter,
then the spiked headboard.
Then, Ilyess completes the local anesthesia of the scalp.
Always with the sound of the voice that accompanies it,
Matthew plays with his favorite color.
She entered the body by its lower part,
then run along the spine to invade the whole head,
which then becomes much lighter than the rest of the body.
I then invite Matthew to ride a bicycle,
a weird bicycle, with a square wheel, a triangular wheel.
He pedal, he pedal, he pedal while the whole body vibrates.
The cranial box open,
I invite Matthew to come back here and now,
to break out of his hypnotic trance.
He is calm, relaxed and can do the tests optimally.
Ilyess and the speech therapist
can now map his brain.
IZ: And the tests will follow each other for the duration of the intervention.
On the surface, while I’m mapping,
but also while I remove the tumor.
It’s like a little marathon, 1h30 to 2h, without a break,
during which we are all fully aware, Matthew too,
concentrated and focused to the end.
It’s tiring,
but it’s so important for the success of the surgery,
and for the next life of Matthew.
Nowadays,
we operated under hypnosis 57 patients,
like Matthew, who had a brain tumor.
EF: And how does hypnosis work?
Me, I do not know,
and no one can tell you exactly, precisely,
how does hypnosis work,
but it works.
It is found that during the hypnotic process,
the patient comes out of reality,
he is dissociated:
the body is here, the spirit is elsewhere.
And during the hypnotic trance,
the patient changes his orientation to reality.
He focuses on his inner life,
and then puts in parentheses
the elements of the outside world, which are irrelevant.
It is also said that when you put a patient under hypnosis,
we inhibit the left brain,
the brain of the real world,
to promote the right brain,
the brain of the imaginary world,
but this remains theoretical and, currently,
researchers are working on how the brain works
when in a state of hypnosis.
But, does it still work?
Always ? No.
Most of the time ? Yes.
Because we are more or less sensitive to the suggestions of the hypnotist.
We are more or less receptive to hypnosis.
During a job,
that we recently published in a scientific journal,
we were able to show
that six of our patients did not respond to hypnosis.
We put them to sleep with general anesthesia,
then awake without any particular consequence.
But the low failure rate among our patients –
which represents 10% in our series against 25% in the general population –
can be explained by an increase in sensitivity to hypnosis
in connection with particular events.
Indeed, our patients are motivated,
they are even very motivated, they are active and actors in the care,
because they understand that we absolutely need them
to carry out this surgery.
The disease has burst into their life,
but they, in response, they appropriate the technique of care.
IZ: Hypnosis for awake surgery of brain tumors,
it’s possible, it works.
By taking the time,
by explaining to our patients why and how the treatment is going on,
by creating trust,
accepting this adventure becomes almost self-evident for our patients.
We know that it can be a source of stress,
but it’s also a mark of responsibility,
and that’s all the art of today’s doctor
to put the patient at the center of his care,
without burdening him with the heavy burden of medical responsibility.
Guide our patients, encourage them,
accompany them,
by showing them that they have confidence in their ability to live this experience.
That’s how our patients, these men, these women,
who come to our service for surgery on the brain,
to fight a tumor, sometimes cancerous,
understand that they are capable of doing something extraordinary.
Thank you.
(Applause)
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