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What it means to do brain tumor operations on patients in the waking state

Private lecturer Dr. Katharina Faust is Chief Senior Physician at the Neurosurgery Clinic at Charité – Universitätsmedizin Berlin and does brain tumor operations on patients in the awake state. In order to further optimize this type of operation, its results and consequences, she is funded by Stiftung Charité as a BIH Clinical Fellow. We met with PD Dr. Faust for an interview and learnt not only what the subject of her research project is, but also how many operations in the waking state she has already carried out, how she became a neurosurgeon, and why an interdisciplinary approach is important in her work.

Dr. Faust, the title of your project is “Methods for preserving higher cognitive functions during brain tumor operations in the waking state”. Can you tell us more about this?

I’d love to! It is essentially about improving the quality of life of patients with brain tumors in the long term, by preserving functions and abilities that can be damaged by the tumor or by surgical intervention. An important aim of neurosurgery is to extend the life of the person affected by removing the tumor. However, the interventions often resulted in us giving the patient more time to live, but leaving them to suffer severe impairments or disabilities as well. For that reason, we have increasingly transitioned to monitoring things like movements of the limbs or simple naming of objects during the operation. Yet even when patients were able to walk and talk afterwards, we observed that many of the patients did not or do not find their way back into their lives successfully. This is because important functions were damaged, the location of some of which we do not yet know exactly. These are the so-called higher cognitive functions like working memory, emotional memory, abilities like paying attention or even doing calculations and reading. We want to achieve a situation in which these abilities are preserved in order to enable patients to live their best life after the operation.

How can this be realized?

For better systematization, we need to map locations in the brain to the higher cognitive functions, which, however, is not easily done. For this reason, we first describe which defects in the areas of e.g. attention, recognition of meaning or working memory occur in our brain tumor patients in relation to tumor location. The main objective is to develop, in a second step, the simplest possible tests with the help of which we can monitor brain functions that can possibly be destroyed during the operation – similarly to the way in which we already currently observe speech through the simple naming of images.

Katharina Faust

Funding program
BIH Clinical Fellows

Funding period
From 2022

Research area

Project title
Methods for preserving higher cognitive functions during brain tumor operations in the waking state

Charité – Universitätsmedizin Berlin


From 2014
Senior physician at the Neurosurgery Clinic

From 2020
Executive senior physician at the Neurosurgery Clinic

From 2021
Chief senior physician at the Neurosurgery Clinic

In my opinion, it is also very important that we do not only take care of patients through surgery, but rather by taking an interdisciplinary approach. The follow-up checks, during which we examine whether the tumor has grown, usually take place at longer intervals. As a result, there is often a delay before we learn about the problems that our patients have to deal with in their everyday lives. This is because they turn to oncological psychologists, for example, and not necessarily to us as surgeons. It would be wonderful to be able to involve experts from other subject areas to a much greater extent in order to identify possible cognitive deficits much faster.

And the tests that have already been established, like monitoring speech during the operation, take place when patients are in the waking state?

Exactly. Brain tumor surgery has undergone a sort of change in recent years, as more and more patients are operated on in the waking state. More complex brain functions can actually only be tested in the waking state. The great advantage is that the brain does not feel pain, at least not as far as we know. So patients do not experience any pain when they are operated on in the waking state.

How many operations in the waking state have you performed?

Oh, I can’t say exactly how many anymore. But definitely several hundred.

Can you still remember the moment when you were allowed to operate by yourself for the first time?

That is actually a gradual transition. You are only allowed to operate alone relatively late in your training, because of course there can't be any mistakes when you're operating on the brain. This means that you initially operate in pairs for a very long time and first observe, accompany and assist. The process goes on for several years, during which you gradually learn to stand on your own feet, so to speak. And then you first start with slightly lower-risk surgeries on other parts of the nervous system, such as the peripheral nerves, before you move on to the brain.

You’ve said that it is important to work in an interdisciplinary manner. Can you elaborate on that?

There are many advantages in working together with other specialist areas, as one can benefit from one another and obtain new knowledge that you probably wouldn’t have obtained without this collaboration. In my opinion, you not only improve medicine itself by working in an interdisciplinary way, but you also expand your own competencies.

As chief senior physician you must be very busy. Does the fellowship allow you enough latitude?

Yes, even if current clinical problems like staff shortages counteract this somewhat. But with the fellowship, I have the unique opportunity to actually create this freedom for myself. It is also extremely useful, as I can continue to train and network with other neurosurgeons. The fellowship provides me with the financial possibility to travel to other clinics and centers in order to exchange views and receive further training.

What led you to become a neurosurgeon; have you always been fascinated by this specialization?

I actually came to neurosurgery in a roundabout way, as I’m not someone that has ‘always’ wanted to become a neurosurgeon. After finishing school, I had many different interests and did not know exactly what I wanted to do one day in terms of my career. I studied physics for a while, because I thought my future lay there. However, at some stage it became clear to me that I wanted to go in the medical direction, because I - as trite as it may sound - wanted to help people in as direct a way as possible. Physics is incredibly exciting. But I think that in physics, for example, you often have to work towards something for a long time before there is a potential benefit for people and society. In medicine, you get feedback from your patients almost on a daily basis. I think that in your work as a doctor you can make an immediate, valuable contribution to society, however big or small this contribution may be. I have always found the brain to be by far the most exciting of all the organs. During my practical year, I realized that I have a penchant for operating, which is why I focused on the surgical field.

What advice would you give to the younger generation of medical professionals?

For one, to take as much as they can from their training. And secondly, perhaps not to commit themselves to a certain direction too early; to remain open-minded and impartial. You never know what might be waiting for you. And the best things tend to happen if you are brave and dare to do something. I also think it’s important to pay attention to your gut feeling and to always believe in yourself. Everybody battles with doubts, that is completely normal.

What do you do in your free time? Do you have any hobbies?

I try to spend as much time as possible with my family and friends and get my mind off things. In my free time, I like to deal with topics that are far removed from medicine. I often read works on physics, for example, and think back to my time studying physics. Apart from that, I’m a yoga fan, as it allows me to find a wonderful balance to my everyday work.

And finally, a fun question: If you could invite three people (alive or dead) to dinner, who would that be and why?

I haven’t thought about that before, but the first person that comes to mind is Marie Curie. I think she’s an incredible person and I would very much like to know how she managed to do everything she was able to achieve during her life. I would also be very excited to have David Bowie as a guest, as I’m a huge fan, and he shaped music history and culture in a unique way. Who else?  Maybe Elon Musk. He has changed our contemporary world more than just about anybody else, and I would very much like to know exactly what kind of person is behind it all.

February 2023 / Marike de Vries & Marie Hoffmann