Mapping the mind

Winter 2018
Webster Pilcher '72 in a doctor's white coat before MRI screen

Webster Pilcher ’72

When Webster Pilcher ’72 performs brain surgery, he first drills holes in the patient’s skull, removing a portion of the bone, like taking the top off of a Halloween pumpkin. Then, he asks his patient how he or she is doing. As a practitioner of awake brain surgery, Pilcher needs his patients to be conscious while he works so they can help him in an extraordinary task: mapping their own brains. “We tell them at the outset that they have a very important role to perform,” Pilcher says. “Unless they can contribute, we can’t do the surgery.”

Brain mapping is at the cutting edge of neurosurgery, wedding research using functional magnetic resonance imaging (fMRI) with clinical practice. During surgery to remove a brain tumor, for example, Pilcher asks his patients to perform tasks involving language or motor skills, then watches the parts that light up on the fMRI screen, so he knows where to avoid cutting with his scalpel. This summer, Pilcher became the first neurosurgeon to use brain mapping for the part of the brain that controls music — cutting a tumor off patient Dan Fabbio’s brain while he sang in the operating room.

Pilcher developed a fascination for human behavior as a sociology and anthropology major at Colgate. “I became extremely interested in why people behave the way they do,” he says. At the same time, he fell in love with central New York, eventually moving with his wife, Allyson, to pursue an MD and PhD in neuroscience at the University of Rochester. Now chair of the Department of Neurosurgery at the University of Rochester Medical Center, Pilcher initially began performing awake brain surgery on epileptic patients in the ’90s, before initiating the brain mapping program in 2011 with Brad Mahon, an associate professor of brain and cognitive sciences.

Just as people vary in height and eye color, so, too, do our brains differ. So while scientists have been able to identify general areas that correspond to functions such as speech and motor control, they can’t pinpoint the exact spots in each person. Working with Mahon, Pilcher has patients come in and spend several days performing tests to map their brains to identify areas essential to different tasks. “I tell patients with brain tumors, ‘We need you to leave the operating room the same person you came in as,’” Pilcher says.

In the case of Fabbio, he had a gift for music — hearing harmonies even in mundane sounds like his electric toothbrush. Last year, however, those harmonies stopped, and music seemed flat and one-dimensional. A doctor in Utica discovered the brain tumor and referred him to Pilcher, who worked with Mahon and a music professor to devise a series of musical exercises that would help create a three-dimensional map of the brain identifying what parts Fabbio used while he played. In the operating room, Fabbio repeated the exercises while Pilcher punctured the tumor like a balloon and gingerly peeled it off the brain.

The moment of truth came when they gave Fabbio his saxophone to play a song, which he performed perfectly. “We all applauded, of course,” Pilcher says. “Then we had to get back to work closing up his skull.” While the operation was the first of its kind, Pilcher sees it as only the beginning of what could be accomplished in translating research into practice and back again. “We have the ability to use the operating room not only as a place of healing,” he says, “but also as a place where we can push the boundaries of how we can operate in the future.”

— Michael Blanding