The guy is awake but not fully awake, this is similar to practices done in functional neurosurgery. Often times they are not playing superbly, but they do it the entire time the surgeons are working near sensitive areas because the surgeons can hear minor changes in how they play that indicates what they are doing is influencing neural operations. For bathroom, they have a catheter in and they would be on a diet prior to the surgery to prevent bowel moments during the surgery

A lot of times for awake procedures they are just asking questions to track understanding and speech generation, listening to hear a thickening of the voice or incorrect word retrieval. When they do this procedure asleep, sometimes they insert an electrode in the brain and listen to the sound of the electrical activity to hear if they are influencing brain function(though more commonly they use micro electrode recording just to identify the right location in the brain)

Disclaimer: I'm not a doctor, I'm an engineer. I just develop tools for functional neurosurgery and observe a lot of neurostimulator placements where they often do stuff like this. Once I saw a guy playing an accordian!

From my limited knowledge and from reading the article, the patient didn’t play the saxophone the whole time, just during integral times.

Similar success without it - maybe but the brain is quite complex and no two brains are the same. Without the patient being awake and playing the sax, thereby activating those neural pathways to check if they are working properly, likely less of a probably of the same success. This helps the surgery team map which nerves are critical.

In the article it says that playing the sax is important to the patient and they wanted to make sure that the patient would still be able to play after the surgery. It’s important that not only surgery is successful but that the patient has a good quality of life. It doesn’t necessarily have to be playing the sax but could be any number of things that would be important to the patient - singing, playing the piano, dexterity in hand movement, etc.

Bathroom - they usually place a catheter so the patient wouldn’t feel the need to #1. Usually before any planned surgery, it’s required to not eat 24 hours before so #2 is unlikely. For craniotomies, usually you can eat a light snack if it’s before midnight.

Because other commenters weren't specific, the point is to ensure that the neurosurgeon stays away from areas of the brain that affect saxophone playing, because he'd abruptly start to mess up before permeant damage is done. In older medical dramas you'd see them do simple cognitive tests to assess the patient at various points through a surgery, this is a more advanced (albeit eclectic) method but is the same idea. Why a sax? Presumably the surgery is done in either parts of the brain associated with musical ability, or hand-eye coordination. I feel personally this is a great idea, I'd love to spend a terrifying surgery say, playing a video game, rather than literally thinking about nothing but the metal knife currently cutting into my soul. A side benefit of making the surgery safer is just gravy in my opinion.

They can test an area before making a cut. They see a section they need to excise they test by touching it, if it dramatically affects speech or motor skill, they look for another spot. Source: neurosurgery nurse explained the procedure before.

why don't you read the article? it explains everything in plain english.

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