Residents of the Treasure Coast now have access to highly advanced neurosurgical procedures close to home, following a medical milestone at HCA Florida Lawnwood Hospital in Fort Pierce. Recently, neurosurgeon Dr. Oszkar Szentirmai and his specialized medical team successfully performed the hospital’s first awake craniotomy, a complex brain surgery where the patient remains conscious to help doctors map critical brain functions in real time.
The patient, Francisco Rosado, was diagnosed with a grade 4 glioblastoma, an exceptionally aggressive brain tumor located in the left frontal lobe. Because the tumor was situated dangerously close to the brain’s speech center, Dr. Szentirmai opted for the awake craniotomy to ensure that removing the diseased tissue would not compromise Rosado’s ability to communicate.
This procedure is typically only done at major academic centers. Lawnwood Hospital now has those specialized anesthesiologists and neurosurgical teams in place so that we can safely perform them here on the Treasure Coast.
While the idea of remaining conscious during brain surgery can seem daunting, the procedure is carefully calibrated. The surgical team numbs the scalp to prevent pain while opening the skull. Because the brain itself lacks pain receptors, surgeons can operate on the tissue without causing discomfort. During critical moments, the anesthesia is managed so the patient can be awakened to perform simple tasks, such as counting, moving fingers, or identifying images.
Dr. Szentirmai compares the brain’s intricate pathways to a city crisscrossed by highways, with specific routes carrying vital signals for speech, movement, and sensation. Since brain function mapping varies uniquely from person to person, simply looking at an MRI is not always enough to predict where these pathways lie. By stimulating areas of the brain and watching the patient’s immediate responses, the surgical team can safely navigate around essential neurological highways.
During the three-hour operation, Rosado was asked to look at images on Dr. Szentirmai’s cellphone. Taking into account Rosado’s prior difficulty with distinguishing certain colors, the medical team tailored the visual test. The anesthesia team was also prepared to converse with Rosado in both English and Spanish to thoroughly monitor his bilingual speech capabilities.
The surgery proved to be an overwhelming success. Key outcomes from the milestone procedure included:
- Rosado correctly identified an image of an apple on the cellphone screen just before the surgical team concluded the operation, proving his cognitive functions were intact.
- Within a day after the surgery, his memory and ability to recognize family members rapidly began returning.
- Post-operative speech difficulties, balance issues, and weakness resolved within two to three weeks, leaving his speech measurably better than before the surgery.
Following the initial surgery, which Dr. Szentirmai likens to the first major punch in a boxing match against cancer, Rosado will undergo subsequent rounds of standard glioblastoma treatments. This includes targeted radiation combined with the oral chemotherapy drug temozolomide. Moving forward, the goal of modern neuro-oncology is to offer personalized treatment plans based on the distinct biology of an individual patient’s tumor.
Dr. Szentirmai brings a wealth of world-class experience to the Treasure Coast region. A graduate of Semmelweis University, he completed his residency at the University of Colorado and pursued elite fellowships at Massachusetts General Hospital and New York Presbyterian Hospital. His practice is currently based out of HCA Florida Neurosurgical Specialists-Lawnwood in Fort Pierce, marking a significant step forward for advanced, localized neurological care available to the Indian River County and wider Treasure Coast community.
