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What exactly is deep brain stimulation surgery?

Deep Brain Stimulation (DBS) is a form of functional neurosurgery during which fine wires, electrodes, are inserted into tiny nuclei deep inside the brain. The electrodes are then empowered using a battery pacemaker, very similar to heart pacemakers. The electricity thus delivered into the brain can modulate abnormal brain activity in a range of conditions towards normality and thus improve the symptoms. The whole system is implanted internally and chronically; therefore, it provides continuous treatment 24/7. It is most used in patients with movement disorders such as Parkison disease or tremor but also other conditions such as intractable pain and epilepsy; its use in many psychiatric conditions remains under trial.

When a patient remains awake during the surgery and plays music eg the clarinet, what does that live music reveal about the brain that no scan ever could?

DBS is a form of functional brain surgery ie surgery to correct abnormal brain function. Thus, unlike most surgery which is driven largely by anatomy, in functional neurosurgery, our focus is on the physiology. Now to my mind, the best way to assess brain function in theatre is to have the patient awake during the operation. That way one can directly and real time assess the patient, both to optimise the benefits of the surgery and minimise the side effects.

Thus, if one of the main aims of the surgery was to preserve the ability of the patient to play their music, in this case the clarinet, then having them awake playing the instrument would be the best way of assessing if we were achieving that aim. In 2026, no scans, electrical recordings nor indeed any other technology can provide us this level of certainty when operating on a human brain. 

How did the idea of bringing music into neurosurgery begin, and what scepticism did you have to overcome to make it possible?

So, this is not the first time that I have done this! In 2020 I operated on a patient, another musician, with a very large brain tumour whilst she remained awake to play the violin. I am a great believer in patient-centred care. As such before any major surgery, I do a goal setting exercise with my patients to understand fully their expectations and goals from the surgery.

This is a very open and honest exercise; all goals are open to discussion and I remain totally honest what I can realistically provide and what I cannot. I guess this is my way of providing true personalised care. Thus with respect to the 2 musicians I operated on, they both wholeheartedly asked me to preserve or restore their ability to play their music as this was so central to their quality of life. This is reasonable, isn't it? All then I had to do was to work through the logistics and come up with a surgical plan. Scepticism is neither here nor there; I don't have much time in my life to pay attention to this!

Is music in the operating theatre simply calming, or is it actively changing surgical outcomes and the way the brain responds in real time?

In the context of a surgery aimed at preserving or restoring music related function, then the music the patient plays directly affects the outcome. My team and I listen to every note, assess every finger movement and constantly interact with the patient whilst doing the surgery. The goal is to ensure the patient's disease is treated, be it a tumour which is removed or a tremor that is abolished, whilst at all times the pre-agreed aim of the surgery, to protect patient's music, is strived for.

The talk moves 'from the surgical to musical theatre', why is breaking the boundary between medicine and the arts now a scientific necessity, not a novelty?

Boundary?! What boundary? I have never looked at surgery as anything but an art. Surgery is the art of delivering healthcare based on scientific principles. Putting concepts aside, there are many similarities between surgery and commonly defined art forms: they are all largely manual, require dexterity, with an inherent need for vision beyond the ordinary. Perhaps it is not a surprise that many surgeons are also good musicians!