Sen. Edward M. Kennedy chose to undergo yesterday's brain surgery at Duke University after some of the country's top medical experts disagreed with specialists at the Boston hospital where he was initially treated.
Dr. Allan H. Friedman, co-director of Duke's brain tumor center, was among those who favored an aggressive attack on the tumor that triggered a seizure last month, alerting doctors to his condition, according to a Johns Hopkins physician who consulted in the case.
Friedman, an internationally known neurosurgeon, announced yesterday that the 3 1/2 -hour operation went well and that his patient was talking and in good spirits afterward.
"I am pleased to report that Senator Kennedy's surgery was successful and accomplished our goals," said Friedman. "Senator Kennedy was awake during the resection and should therefore experience no permanent neurological effects from the surgery."
Brain surgery while a patient is awake is becoming increasingly common, said Dr. Henry Brem, director of neurosurgery at Johns Hopkins Hospital and a consultant in Kennedy's case.
To determine whether removing additional tissue will hinder their patient's ability to function, surgeons electrically stimulate the area and observe the effects. The current temporarily blocks signals produced by the tissue, mimicking what would happen if the tissue were removed.
A neuropsychologist standing by engages the patient in conversation and judges whether removing the tissue would be harmful.
The operation is aimed at extending Kennedy's life but does not cure the condition, experts say. Average survival for similar patients receiving a combination of surgery, chemotherapy and radiation is two years, double what it was not long ago.
On Friday, experts from some of the nation's elite neurosurgical centers met at Massachusetts General Hospital to discuss the 76-year-old senator's treatment options.
Surgeons there, who had removed a sample of the tumor for diagnostic purposes, apparently recommended a combination of chemotherapy and radiation without further surgery.
But Dr. Henry Brem, who consulted in the case but was unable to attend the session, said several experts argued that surgery and follow-up treatment offered the best survival chances. Attending the meeting were Friedman; Dr. Stuart A. Grossman, a Hopkins neurosurgeon; and specialists from Massachusetts General and the University of California San Francisco.
