Rome — A musician had a brain tumor removed in Italy this week in a nine-hour surgery that he spent not only awake and fully conscious, but playing his saxophone. The 35-year-old male patient had the procedure at Rome’s Paideia International Hospital on Monday and was discharged early Thursday morning. 

Dr. Christian Brogna, a neurosurgeon and expert in awake surgery, told CBS News the tumor was removed successfully, and that there were no negative impacts on the patient. Brogna led a highly specialized 10-member international team for the procedure, using state-of-the-art technology. 

“The tumor was located in a very, very complex area of the brain,” said Brogna. “Moreover, the patient is left-handed. This makes things more complicated because the neural pathways of the brain are much more complicated.”

The doctor said his patient, who has been identified only as C.Z., played the theme song from the 1970 movie “Love Story,” and the Italian national anthem, at various times throughout the surgery. 

During the meticulous preparation for the surgery, C.Z. had told the medical team that preserving his musical ability was essential to him. It was also very useful to the surgeon, because his patient playing the sax during surgery allowed Brogna to map different functions of the brain as he operated.

“To play an instrument means that you can understand music, which is a high cognitive function. It means you can interact with the instrument, you can coordinate both hands, you can exercise memory, you can count — because music is mathematics — you can test vision because the patient has to see the instrument, and you can test the way the patient interacts with the rest of the team,” he said. 

Brogna, who has performed hundreds of awake brain surgeries, said the key to pulling off such a complex operation, was preparation.    

“Every patient is unique, every brain is unique, so we really need to know the patient very well,” he told CBS News.

Over a period of about 10 days before the operation, the patient met with the medical team six or seven times. He said it was important to the surgeons to respect the patient’s wishes as to which functions they felt were most important to preserve. The process led to what Brogna called “a massively tailored surgery.” 

During the preparations for this and any other brain surgery, Brogna said the team looks at the entire person, not just the pathology. 

“When we operate on the brain, we are operating on the sense of self, so we need to make sure that we do not damage the patient as a person — their personality, the way they feel emotions, the way they get through life. The patient will tell you what is important in his life and it is your job to protect his wishes,” he said.

The preparation period also ensures the patient knows every detail of the procedure before it happens. During surgery, that helps ensure they remain quiet and collaborative, not scared, said Brogna, adding that that there is an atmosphere of “great calm, great silence” in the operating room during the procedure. Apart from the saxophone, of course, in this case.

Brogna said he was proud that his patient had been able to go back to his normal life, and proud that with each operation, knowledge of this branch of medicine is advancing.   

“Every surgery is a window on the brain, on how it works, and while we are learning, we are taking the whole of the person — his life, his passion, his hobbies, his job — into account,” said the surgeon. “That is the goal.”