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When Greg Bender woke up one January morning, he knew something was wrong.
The 72-year-old retired engineer found himself unable to form sentences. Instead, every question from his wife or the emergency team was met with the same puzzling phrase: “It’s a fountain day.”
“It was the only thing I could say,” Greg recalled. “I knew something wasn’t right, but the words just wouldn’t come.”
After scans and follow-up imaging, doctors discovered the cause: a tumor near the speech center of his brain. That discovery set Greg on a path toward a groundbreaking procedure — the first awake mini-craniotomy performed at HonorHealth.
What it means to stay awake in brain surgery
For most people, the idea of being awake during brain surgery sounds impossible, even terrifying.
But for Peter Nakaji, MD, neurosurgeon at the Bob Bové Neuroscience Institute at HonorHealth and member of the HonorHealth Medical Staff, the procedure is one of the most effective ways to preserve a patient’s essential abilities — like speaking or moving — while safely removing a tumor.
“Every part of the brain does something,” Dr. Nakaji explained. “When a tumor is right next to areas that control speech or movement, the safest way to know what we can remove is by talking to the patient during surgery. Brain scans can’t tell us what words or movements live in a specific spot as well as the patient can.”
In Greg’s case, the tumor rested near the region responsible for speech. By keeping him awake, Dr. Nakaji and his team could stimulate parts of his brain, ask him to talk and carefully map what areas to avoid.
“That allowed us to protect his ability to communicate,” said Dr. Nakaji. “We wanted him to wake up able to talk with his wife and loved ones just like before.”
Awake craniotomy is a highly specialized area of brain tumor surgery. Usually, it’s done through a large opening in the skull so extensive mapping can be performed. “Sometimes that doesn’t make sense,” said Dr. Nakaji. “We are shrinking the openings for most surgeries to lower the impact on patients. If we only have very specific areas of concern, we can still do the speech testing, but through a small window.”
A conversation in the operating room
Greg remembers that day clearly. After being sedated while surgeons created a small opening, he woke up mid-procedure — alert, calm and ready to talk.
“I remember Dr. Nakaji saying my name and then we just had a conversation,” Greg said. “We talked about Yosemite, where I used to climb and even Niagara Falls, where my wife and I spent our honeymoon. It felt more like swapping stories than being in the middle of surgery.”
Those conversations weren’t just for comfort. They were vital. As Greg shared memories of hiking trails and fishing spots, Dr. Nakaji and his team were mapping his brain in real time.
“We learned quickly that Greg was a natural conversationalist,” Dr. Nakaji said. “That fluency gave us confidence as we worked, ensuring we could remove what we needed while keeping his speech intact. We did a variety of language tasks, but most of it was wrapped up in what felt like a good chat.”
A new chapter for HonorHealth
Awake craniotomies aren’t new to medicine, but performing them in a highly tailored, minimally invasive way is still rare according to Dr. Nakaji.
“Doing it through a smaller incision shortens recovery time and reduces risks,” he said.
Greg’s surgery was not only a success for him — it marked a milestone for HonorHealth. “Awake craniotomies weren’t being performed here,” Dr. Nakaji said. “It reflects the overall growth in neurosurgery capability at HonorHealth. The whole neurosurgery team is bringing cutting-edge techniques to our community, so patients don’t have to travel far for world-class care.”
That local access mattered deeply to Greg and his family. “The idea of flying somewhere else for surgery wasn’t realistic,” Greg said. “To know I could get this level of care here, with a doctor who took time to explain everything — it made a tough decision so much easier.
Facing fear with trust
Agreeing to stay awake while surgeons worked inside his brain wasn’t an easy decision, but Greg said the choice quickly became clear. “When Dr. Nakaji explained that the results were usually better if I stayed awake, I thought — why wouldn’t I want that? There was no downside. I trusted him completely.”
That trust — between patient and provider, between family and care team — is at the heart of HonorHealth’s approach. As Dr. Nakaji put it: “Our goal is always twofold: treat the disease and protect the person. Preserving speech, movement and what makes someone who they are — that’s just as important as removing a tumor.”
Life after surgery
Today, Greg is back home, spending time with his wife and enjoying the outdoors he loves. His speech is strong, his recovery steady and his gratitude evident.
“I look back and think — what an incredible thing,” he said. “To be awake, to talk about Yosemite, to come through it and still be myself. I’ll always be thankful that this was possible right here at HonorHealth.”
A future of innovation
For HonorHealth, Greg’s story is more than a medical milestone — it’s a glimpse into the future of collaborative, personalized care. Awake craniotomy will now be an option for others facing similar diagnoses in Arizona, offering them hope for both healing and quality of life.
“We want people to know they don’t have to choose between expertise and compassion,” Dr. Nakaji said. “Here, they get both.”
Greg agrees. “From start to finish, it felt like everyone was working together for me. That made all the difference.”
