A surreal surgery for an unexpected diagnosis: Tanner’s story
Tanner McIntosh was running a 5K race that he’d done multiple times before, and while he didn’t expect it to feel effortless, he was surprised by just how much he was struggling. His lower back, specifically, was in excruciating pain. Somehow, he found his way to the finish line and immediately wrote off the experience as merely a bad day.
This was the winter of 2024. Weeks later, McIntosh, 36, was two days into a ski trip when the lower back pain returned. It was even worse this time. In fact, it was a level of pain he says he’d never experienced before.
McIntosh, who lives in Lancaster, saw his primary care doctor, who recommended he work with a physical therapist for a few sessions. He did so but found no relief from his back pain, which had become more persistent, if anything.
And then in the early spring a new twist emerged: spasms in the same area of his back where the pain was coming from. But these weren’t typical spasms because he also lost the ability to talk during the episodes. McIntosh returned to his primary care doctor. With news of this latest symptom, he ordered a brain MRI, which would provide a detailed image of McIntosh’s brain.
The MRI scans revealed a “moderate size” mass that was situated right next to his primary motor cortex, a region of the brain located in the frontal lobe that’s integral for controlling voluntary movements, including talking.
‘The right surgery for a very specific patient’
The primary care doctor promptly coordinated a treatment team that included Eric Hintz, MD, a neurosurgeon with Penn Medicine Lancaster General Health. McIntosh and Hintz met for the first time early in the summer of 2024, and Hintz recommended McIntosh undergo an “awake” craniotomy because it gave Hintz the best chance of removing the tumor, or as much of it as was possible.
But because of its precarious location, the surgery was not without significant risk. If Hintz infringed on the primary motor cortex, it could cause lifelong impairments. To prevent this from happening, McIntosh would be awake for parts of the surgery so that Hintz and his team could continually test his brain functions.
Hintz describes this complex surgery—which he’d done before but had not previously been performed at Penn Medicine Lancaster General Hospital—as “the right surgery for a very specific patient with tumors in a very specific set of locations.” Aside from where his tumor was situated, McIntosh fit this profile because, Hintz said, he was, foremost, otherwise healthy.
Protecting the airway is every anesthesiologist’s primary concern during surgery. This is typically done by inserting a tube into the patient’s throat. But that’s not possible during an “awake” craniotomy. So, the patient needs to have a certain degree of strength and stamina in order to breathe without the aid of a tube for what turned out to be a roughly four-hour-long surgery.
Secondly, McIntosh seemed, to Hintz, to be mentally strong, too. Not everyone can maintain a sense of calm knowing that on the other side of the curtain, a surgeon is prodding their brain. McIntosh, who felt like the surgery happened “super-quickly,” said, “It was really kind of an out-of-body experience.”
When asked if he was afraid of the surgery, McIntosh said, “I had the benefit and blessing of having a comprehensive support network, so there were a lot of people who were afraid for me. I think there was some fear. It was sort of existential. But I don’t really feel like fear is what I would say defined my experience.”
The patient is also a participant
On the morning of his surgery, in December 2024, McIntosh arrived at Lancaster General Hospital with his parents around 5 a.m. He says he wasn’t especially anxious, possibly, he admitted, because he was trying to be strong for his parents’ sake. But he said he was also very confident in Hintz and his team.
When he was wheeled into the operating room, he said, “there were a lot more people than I anticipated.” Among them was neuropsychologist Jesse Main, PsyD. After the surgery began, McIntosh’s next memory is Main later holding his hand and asking him to make a peace sign, among a series of other requests. He remembers Hintz asking him to repeat things. He remembers “a bunch of beeping.” And he remembers other, unfamiliar sounds coming from behind him.
Also among the specialists and nurses in the OR for McIntosh’s surgery was Nduka M. Amankulor, MD, division head of Neurosurgical Oncology for Penn Medicine and Director of the Penn Brain Tumor Center, whom Hintz asked to participate because he does craniotomies routinely.
For the surgery, McIntosh’s scalp was anesthetized. Then his head was placed in a clamp, which involved inserting pins into his scalp. Computer software aligned the images of McIntosh’s brain with his physical head so that Hintz and Amankulor knew where to access the tumor. They then made an incision in McIntosh’s scalp and drilled small holes in his skull so that they could use a medical saw to remove a piece of it.
Hintz suggested that this may have been the most intense part for McIntosh, because of the sound and vibrations from the drill and saw. McIntosh doesn’t recall this specific moment. He was given a local anesthetic that put him in a kind of “stupor,” as Hintz described it. He wasn’t unconscious, as he would have been under general anesthesia, but he was unable to feel pain, and he was breathing on his own.
Hintz and Amankulor cut through the three membranes that protect the brain. At this point, they asked the anesthesiologist to wake McIntosh. As Hintz and Amankulor went about removing the tumor Main frequently gauged his responsiveness and asked him whether he was experiencing any abnormal sensations.
Gaining confidence through his care
McIntosh spent two nights in the hospital after his surgery. He said he felt “a little wobbly” moving around his first couple days at home, but his motor functions were completely intact. For the first week, his mom helped him get up and down the stairs and in and out of the shower. She ensured he ate and took the necessary pain medication. His brother, an emergency room technician, then stayed with him for a weekend.
McIntosh feels he recovered quicker than he thought he would. He began getting the mail. Each day after that, he was determined to walk a little farther. It was harder to feel like he was making progress with the mental side of his recovery, particularly because it would be several weeks before he learned the results of his biopsy.
Hintz said they removed all of McIntosh’s tumor except for a “very, very slight residual,” based on an MRI that was done after the surgery.
Still, “it was very much something that I was going through,” McIntosh said. “There are times when you kind of forget that any of this happened. And then you catch yourself.”
The biopsy revealed that McIntosh’s tumor was a grade 3 astrocytoma, a fast-growing brain tumor made up of astrocyte cells, which typically support and protect nerve cells in the brain and spinal cord.
To control the bit of tumor that remains, and because, Hintz said, there “may be additional tumor cells beyond the borders of what looks abnormal on MRI,” McIntosh is undergoing six weeks of proton therapy, a type of radiation therapy that uses high-energy protons to damage the DNA in cancer cells. It’s considered noninvasive, precise, and painless. Upon completion, he’ll begin chemotherapy. He’s also continuing to follow-up with his treatment team, which includes Hintz, medical oncologist Srilatha Hosur, MD, and radiation oncologist Melissa Afton Frick, MD.
McIntosh gushes with gratitude for Hintz and the many other specialists and nurses who have had a hand in his treatment, not just for their expertise but also for keeping him grounded and optimistic during what has been an overwhelming ordeal.
“No one ever wants to go through this,” he says. “But having this support system in place for my own journey has helped me to feel like I’m in the best hands at every turn.”
Seen in the news: The collaboration behind the craniotomy
The groundbreaking procedure showcases the advanced neurosurgical capabilities now available to Lancaster County residents. It was achieved, in part, through collaboration with the team’s Penn Medicine colleagues in Philadelphia who perform awake craniotomies more frequently. As the LNP/LancasterOnline reported, prior to McIntosh’s surgery, the team came to Philadelphia to watch the procedure in real time—including the anesthesia team, for whom it was even more important to monitor their patient’s breathing since he would not have a tube in his throat, so he’d be able to communicate. Hintz said, “Tanner’s surgery was the culmination of months of work and coordination.”