and cannot comment on this issue without a very broad green or even a smile, because it's just a clownish gesture on the part of the most extreme right. member of the coalition who always uh, come up, but uh we use uh, some outland beach ideas. it has uh nothing to do. we realized in the israel now and uh, you know, a 2 people spent uh, 20 feet about waving the flag and the 3rd president comes over. but spencer, for use the policeman, mary, going to arrest them. obviously, pieces, not enforceable juice, drug patient just and now they're street in the face of peace loving people. um either a police geniune always really. but nevertheless, what is the earliest i can do is booked up the to flex to gather if

they had the sort of an emblem where the police geniune and these relevant legs of flying. who's going to take down this double leg, which includes these rally? well, so there are many ways to bypass base uh, mockery of legislation. all right, let's just about wrapping up this program for now. here on how to internationally from all of us here at all to international headquarters in most go a special haven't even us. thank you for sharing your time with us. you can catch up with all of us story that all c dot com, but also any number of about 10 of grand try the meantime, the,

the whole up shelves is not that bright and he isn't even worse. and german chancellor, though he is self aware enough to understand and acknowledge some nations, the double standards on russia, neo colonial thinking. it would seem dice hard. the, our brains are fascinating. they control everything from our ability to function to experiencing emotion. in fact, your ability to understand what i'm saying to you right now comes down to the amazing functionality of your brain. and yet there's still so much that we don't

understand about how our minds work. so what happens when things go wrong up here will to find out the answers. we came here to speak with you good, mid john hughes. what are the worlds for most of neurosurgeons utilizing state of the art technology and progressive techniques? the during and a week brain surgeries of the patient is fully conscious. how accurate is this method? we what operating on a young woman with a brain to most of that. we also have to reside, to put in a when she finished the time, i realized she couldn't talk. and thanks for the her ability to speak came back up to 3 days. and we've been good friends ever since the how do you know we're not to go if for some stops speaking or produces and

irrelevant words, this means to us that the distribution worked, the or the operating room is like an old district where everyone has to know what they're doing and when they must do it, you perform brain surgery at to remove tumors. and the patients that you're operating on have a type of anesthesia where they are still awake. and talk to me a little bit about what the patient is feeling is this kind of state in between dream and being awake, where they fully conscious during this process. what does the patient feel? i know about this, but what are you doing and a weak brain surgery, the patient is fully conscious because the completely awake were able to precisely identify the borders between different areas of the brain. so if the patient were

in a semi conscious state with these, we wouldn't be able to determine our distance from the specific neuro pathways associated with speech. so um, once the school is open and they're on the table. so what do they actually feel? i mean, did they feel any pain? did they feel any um or is it the difference between being able to speak and actually being able to feel something what. what do they feel at that moment? know me and probably the font awakening if the patient doesn't feel any pain, that's all the interest that we use a special type of regional anesthesia. and that even the, when the nerve endings all the way around the head. and so there is no pain. the tool, however, as we remove the cima, there might be areas as the brain where a person may feel some pain, were aware of this problem, and always trying to attain. for example, if the tumor reaches all the way to the bottom of the cranial fall, so the floor of the cranial cavity,

so we know that the patient could experience discomfort during surgery and we, in that case, we will sometimes remove the parts of the tma that is like the to cause the pain that's in the one, but only if we a sudden it wouldn't affect the patient's quality of life. and after that we wake the patient up and remove the rest of the tumor in the mall. how to reach areas. so our bodies make many uncontrollable movements a little flinches, a little take here and there. so that can be incredibly dangerous when you're actually operating on someone, what sort of safety precautions do you use to make sure that the patient does not move while you were operating on them? is it something as extreme as you really have to tie them down or clamp them down to the take to know of a peer with a new kind of the 1st day. but not everyone is suitable for a wake surgeries in think that the some patients shall we say less psychologically stable than others. and um, if there is a tension or some involuntary movement,

enjoying the operation, then could be dangerous. can you think? but which is why they fall every surgery, patients undergo a series of tests with a psychologist or with a new era surgeon. and then a nice steel is just a little missing before we talk to the patients and seeing if they're comfortable with the weight. so into a 2nd to the yes, we do secure the patient's body before surgery, but something thinks the cranial fixation. we use a special device called the mayfield, that's going to come fix here if it doesn't have to patients, but didn't show. so this goal is how tight in position if the horses lift gate, the patient is strapped down on the table or something can still make small movements. more of the head is completely in mobilized below anymore using ero navigational technology. we identified various areas of the brain by looking at special reference points. so it's very important for the patients had to stay fixed . so one more thing is the patient has to remain on the operating table for 2 to 3 hours, virtually motionless, to feed them for

a healthy person that's quite challenging. so when we place the patient on the table, we're trying to make sure they're comfortable that we smooth out all the folds, put an object down to the feet, et cetera, to make them post you as natural as possible. i. so it's hard for me to imagine being in this position actually being on the table having someone working on my brain. and i hope i never have to be in this position, but it, has it ever happened? wait, while you're operating, the patient starts to misbehave or you notice something is going wrong or not the way that you would like it to go. what happens in your mind in that moment? yeah, yeah. that's not exactly how it works here that, that i think we talked to our patients before the surgery. i'm go over all the potential complications with that. but i think you might have noticed that we 1st stimulate the cortex that came with them. then the some cortical structures to determine the distance from the neuro pathways involved in movement in speech.

occasionally, as we stimulate the brain with that person might have an epileptic seizure. and even if they've never had one before in that life. naturally, patients get scared when this happens. that's what we told them through the scenarios beforehand. if we've got all methods to stop the seizure and keep the person lucid away, once they come down, we resume the surgery and document that i want to. i mean, it's possible that what you're doing, it can cause damages that are reversible yet that they've sent me it's, i'm, is mostly opening as go doesn't know last thing, damage to the brain to see it the most been, you know, it's a well established fact. easiest thing, surgery like this is relatively common with if we open the skulls of both awake and unconscious patients, it doesn't damage the brain tissue on its own, unless we damage the functional areas of cause. successful surgery makes patients

a neurosurgeon is happy. and so my understanding, the idea of your approach is that the tumor has no specific boundaries but or you have under a linguist present to help you kind of figure out where those boundaries are in real time. so how accurate is this method way? is sports in the method code stimulation the we know that one milli i'm to, i mean roughly translates into one millimeter to the pos way responsible for language scales in motion. if we set, say 10 or 20000000 pads and we see distortion, but we know that we have 10 to 20 millimeters from the pulse way to keep, then we can go further safely and we do that and we see that there are no tumor cells left the, we still have office send to me to, to the pos way, so we can safely remove a few more millimeters of tissue. because as you noted correctly, the brain tumors are invasive. they don't form an egg shell,

they infiltrate the surrounding tissue, sadly is on the most we have to do that. remove mute, so to speak, areas of the brain that will cause any disorders of to the surgery. you, sam, just to be clear for our, um, our viewers. uh, it's important for you to have the nursing with, with you in the operating theatre at that moment while you're operating, correct, as he is taking me to it again, no techniques like this do exist. well now is the easiest for us to identify language and motion senses, and these zones, it has to be said that the left hemisphere, the human brain is responsible for the right side of the for the, on the right is responsible for the left side respectively. the purple face, but this was in the way if you all right handed your left hemisphere is dillman on to the mean and all these important structures of the different quotes and see what the sometimes the tumor is in the right hemisphere. enough, it's not dominant. obviously, but it still has to functions that like cognitive spatial orientation on the food

techniques exist to perform special tests during soon as you read, for example, during surgery of the right to know the to the front of the low. but i think the test will help to find the boundaries of that you might, will need to and do not harm the patient. funny. it's more difficult because although it doesn't stop neurosurgeons from using such techniques, thank you very much for taking the time to speak with us today. this is a fascinating subject, so let's get right into it. so you know that a specific part of the brain is responsible for speech, but every single brain is different. so when you're getting ready to work with someone who's going into surgery. so how do you know what parts to work with and what parts to stay away from? is there some imagery, do they light up on a computer screen somehow and talk to me about that process? welcome to all center full english and brain. so you're right, there is a typical map of language in the brain. it's most lovely to realize that most of

the people it with the left hand, if uh, but uh, during the grows over to you where the entire network is organized. so before hand, we just don't know, well language is in this specific 1st so, so we need to do a very specific procedure which is called in trial front of the language mapping and identify them. interesting. so we know that in order to map out that those speech areas, you do tests with each individual patient, you speak with them, have them do maneuvers if you will with their brain. are they different for each patient? maybe someone who is good at math, they do math problems, someone is good at music, maybe listen to music and how do you know where to work with an a person's brain and brain is not a good potential. there is functional specialization full language for other cognitive functions and within language,

there is different areas of the brain i involved in various aspects of language. for example, the temporal low of the left hemisphere is mostly a doing a language processing language comprehension of the front, the loaves, a more involved in language production. so depending on where we are, we select specific tests to sense the different off for the specific area. so when we were actually in the surgery and we were watching this whole process, how do you know you're speaking to the patient? the patient is aware of what's happening and how do you know we're not to go? is it something that you can see on the computer again, or is it as simple as putting a do not touch your sticker actually on the brain. mm. uh for example, we're in the interior or frontal lo. uh,

so the most specific task for it is extra naming. so we presented pictures of actions and ask, what is the hero doing in a picture. okay, so for example, sitting jumping, dancing, and we present each pro for 4 seconds. this is a virus with protocol during those 4 seconds, and neurosurgeon stimulates the brain inhibiting this specific hobble send to me the area. and if a person stops speaking or produces and irrelevant words, this means to us that then have patient worked. this area is eloquent for language . we market with that specific sticker and the newer surgeon makes his best not to reject this area. so near linguistics and narrow surgery,

very different fields. i mean, one involves cutting into the brain and one involves studying the brain. and do you have to have some experience in actual neurosurgery in order to understand what he's doing? do you talk to me a little bit about your experience there? there was no uh, formal education for about this is what we learned during actual work and it takes a lot of time to train our students. during that i of course we should speak the same language with the nurse mentioned. we should know very well the stages of new or surgery. uh, we should interact in america here in a way. that's why i would say we shouldn't be aware of many neurosurgery details, but in 10 neurosurgeon learns new or linguistics with us. so they know which area is involved in which aspect of language and then your searches.

we're working with a very linguistically informed, they know about phonemes, morphine and physics. what can i, i guess this can be different for each individual case, but a talk to me a little bit about what does brain damage due to a person's ability to speak. so the sequences can be different. uh, production and comprehension can be impaired. and uh, we could end up with a global aphasia when the person who cannot understand any language and can't produce a word. and that's very often new or surgery. it's more relevant for post stroke or pages, for example. but if we were to do the,

into all sorts of mapping the neurological language, a negative consequences wouldn't be much more numerous that there are a lot of multis send. the start is devoted to that, and this has proven already you have a devoted much of your life, just studying the brain. you have become the head of the center here. so you know what you're talking about in your time. what has been the most fascinating, the most interesting, the most important discovery about the human brain that you can think of. in fact, one of those, is there a reason last year of the colleagues uh, um, from the west of the u. s. published study with uh, one uh patients reported with implanted electrodes with elect, a cook,

the cobra feet where they recorded the brain activity and then synthesized speech. they made it for 50 words, well trained many times. but i can see that that a super great step forwards in this field. i and we have already started working on that as well. very cool, thanks for taking the time with us today. i look forward to following more of your work. thank your much people have a specific talents for example, their athletes, their artists. one example that i've heard is that someone was actually playing the violin during the surgery because that's something that is important to them. so their livelihood. what do you need to do to specify or to make your surgery specific to a patient and what their talents are? so be, unless you use going here so that there was

a specific sure to take that. the 1st one is that multi lingual person is who can speak several languages and actually have more language centers. one for each language they know i'm ukrainian. so i have dedicated centers for ukrainian or russian languages because of this is also true for you. one for english, one for russian in such cases. and we have to invite the language to assist us. i to we had a tons of patients some time ago, but nobody here knew the to, to a language. and so we had to adapt on tests. so i didn't find an interpreter to ask questions for us a move last time when it comes to violating playing. well, i've seen the videos, but playing the violin involves so many structures in your brain. the damaging one of them would hardly have any considerable of things on disability. only the manual dexterity is critical here. so we usually test language service. sometimes it's also sites in motion zones. i've heard of one method where an alternative method,

where a special dye is injected into the brain and the tumor illuminates maybe a pink color and the rest of the brain illuminates a blue color so that the surgeon can see the difference between where the tumor is and where the brain or the health of the brain tissue is, uh, how is your a method different or even better in this case? no, you really con, cool. this an alternative method. the 2 methods complement each other. and what it sometimes happens is that a to must spreads to the neuro pathways side, which is and fully surrounded by tumor cells. how can i so if that happens using a die to identify that you must, will help us see that too much longer. it will help us see the neuro pathways locked inside it method then the risk is that we can damage them. whereas ensuring quality of life for our patients is our priority. this is why i'm saying that these methods compliment each other. for example, today we had a case of a low grade dma. on contrast enhancement doesn't really work well for them. it's

hard to see them clearly. whereas it works well of a high grade to most cars. but as i already mentioned, the 2 methods a complementary whom it's, i'm to day, for example, i use both that i've seen as well as all just sounds. i need to help me locate all the bits of the, to my i was removing. because even though they jumped the surgeons, i can see everything that was new, it's not entirely true. and we need all the methods we can use to help us see what we need to do here is there is also obviously co co here in this democracy. know c t m, we use that to that. it helps to see whether treatment ends, unhealthy tissue, beginners. so as we've already mentioned, to you work with an or linguist to, to make sure that your work is properly done in terms of uh, what type of a relationship do you have to build with that in your language. it seems to me that you would have to have a lot of trust in that person. is this something where you've worked together

a long time and have developed a relationship where you know each other's language and know how each other operate for? there's something where it's standardized and they just come in and do their job and you come in and do your job. i'm not the, not the chief near a linguist. one said there's an operating room is like an orchestra and everyone has to know what they're doing. and when they must do it, i still, and the patient is usually seen by a new role linguist prior to the surgery. and sometimes the patients may have some difficulties speaking to me. so i'm doing the test. it's hard for us to know whether we've come too close to the neuro pathways more the pathways are already damaged, combined, causing the dfcs. i'm with us clicking thought. this is why the new or linguist. let's see the patients before the surgery and then help us doing the procedure. i once counted a total of 11 people in my uh, including myself, my assistant, near a linguist in a nice deal to just a group notices. and all these people know that segment of what i know want to do,

and when you focus on certain the, the search and tells them when he needs their assistance. because of working as a team, we produce pretty good results, ensuring good quality of life for our patients successfully sample other than removing the brain tumors. um, what are some other situations where someone might need to have open brain surgery? the, it's a, it's a key if they're not yes, with the humans. um, the only reason for open brain surgery able to send me all teams operate on patients who suffer from epilepsy. which if we know, for example, the problem originates in the temporal lobe. and if we can perform temporal re sanction, thinking that we're talking about the so called needs the removal of which one lead to any disorders or video. and this procedure, however, also requires the assistance of a linguist during the operation. when dealing with epilepsy, you need to remove the whole area that generates the cc is otherwise they may come

back. so it takes a lot of study, a lot of practice, a lot of knowledge to do what you do. but it's also said that there is so much that we don't yet understand about the human brain and how it works and how we think, why we think our soul, everything is connected to this. so given all of that information, is it possible to say that there's a lot of luck in what you do? can yes, ma'am. look cool. the operating neurosurgeon plays the leading role the most. he has the most experience so he can see, understand unplanned best of the 0 to i for example, know that right now i from, i'm getting in this particular direction that was done on the you asked me about my, what, when you wrote linguists age both way has a stronger response to specific test. if i'm going to was this specific pathway and now what i'm asking for one set of tests. if i'm going to was a different pathway,

i'm asking for a different set of tests because i'm going to say that about this of in the early stages. we had an interesting incidents again was we will operating on a young woman with a brain tumor was the we were working near the circle with ashley and tried to look at, i'll be honest to, to recite the plan with the cheese, reciting it cheerfully as i'm moving the to monitor, i can see is the thing i'm working on it. a when she finished the time, i realized she couldn't talk there's, there was specialized tests, but each trying suddenly which we must use at every stage and hasn't been them. but life is a journey we keep learning as the design for the her ability to speak came back up to 3 days. we have so i'm, we've been good friends ever since. accustomed to discuss my friend you. because as a student, i decided i wanted to be in your research and the most because there was still many unexplored areas in euros. surgery was that when i was young and bold little that you, i wanted to make discoveries and i'm going to learn more about the brain. however,

the more i learned the more questions and much so my, i realize i don't know this feeling. i don't know that it's true. unfortunately, there are some situations where every neurosurgeon needs lock the system, going to argue with that. but apart from that, i am, if you need knowledge, we may lack complete understanding. but we do know something by and we know that if we operate in this area and we wouldn't do the patient, any home, it's about operating in that area, could be dangerous, something like that. i thank you very much for the opportunity to come and watch you work and to have this experience. and it has been fascinating from the beginning 10. thank. thank you very much. the

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the turkeys already and they told me and turkeys already doing its share as a nate on and that's, but it's not boring by some of the american ideas of kind of we cannot make them. our goal is a guess rush, i think turkey will continue and that's only because the relationship may be beneficial. economic rates. but also because russia has to be a partner in maintaining the international orange, the take a fresh look around his life. kaleidoscopic isn't just a shifted reality distortion by power to division with no real opinions.

fixtures designed to simplify will confuse really once a better wills, and is it just as a chosen few fractured images presented as 1st? can you see through their illusion going underground can frustrating yasser could i start to check the 2nd with them for me to just set them . i'm going to do that. i put it crumbs kimball, add 0. sure left c malachi, already made a what the shots ec set up, that's what's the one in 3 minutes. subordination is inch. reset president, that's missing now flicking while. ok. let's to continue to set them go, no matter who it, but they play metric listed in wordpress. instead of some actual address now click on it with her or something that i moved, but they're building it that whole with packaging video. those mean except which in crash. and then you might have to meet those magic listed. can you move the shows or at least what civil we understand that some of the shows i respect that real