That's where Abhishek Prasad peddled his musical wares during a four-hour surgery in India that aimed to correct cramping in his fingers, his surgeon said.
For 20 months before the July 11 procedure, Prasad had suffered from a neurological condition called musical dystonia, said Dr. Sharan Srinivasan, head neurosurgeon at the Bhagwayn Mahaveer Jain Hospital
"This is a form of a task-specific movement disorder, which comes out only when playing a musical instrument," he said. "In his case, ... it was the cramping of three fingers, middle, ring and little, on his left hand because of the misfiring circuits in his brain."
Whenever Prasad played the guitar, his fingers would get stuck. Not anymore.
"It was a magical feeling, completely magical," the 37-year-old musician said of the first chords he played after the operation. "I wasn't able to play for the past 20 months, and in a few seconds, my fingers were completely released, and I was able to play normally."
"You have been struggling for 20 months to do something and just in a few seconds, you are able to do that normally, how would you feel? It was magical, it was heaven."
Srinivasan performed "radio-frequency ablation" under local anesthetic to correct the condition, a treatment he had trained for in Japan, he said.
The treatment uses radio-frequency currents to destroy the part of the brain circuit triggering abnormal tremors.
After fitting a frame to Prasad's head and using a special MRI scan to map his brain, Srinivasan's team relied on Prasad's reactions to pinpoint the exact area that required burning, the surgeon said.
"This is why the patient has to be fully awake during the surgery," Srinivasan said. "He has to give me a real-time feedback."
"As I am entering the brain, I'm stimulating the brain at various levels to make sure I'm in the right location, I'm not in the wrong location," he said. "Once I confirmed that I'm there, then I started burning the circuits with radio-frequency currents."
Prasad's real-time response was critical.
"As I'm doing it, he kept playing the guitar and he is seeing his fingers releasing," his surgeon said.
Local anesthesia used
Awake brain surgery dates to ancient times, when doctors sometimes drilled into patients' skulls, presumably to relieve seizures or headaches, according to the National Institutes of Health
, or NIH. In the late 1920s, a surgeon in Canada added pain killers and local anesthesia to the practice, which gained popularity in treating brain tumors and epilepsy.
Srinivasan took extra precautions to ensure Prasad was not in pain, he said.
"He was only under local anesthesia, which means wherever I made a cut in the skin, I give an injection, so that he doesn't feel the pain," he said. "The brain itself has no pain, only the skin or the top of the skull that is painful."