Brain Surgery

So I saw my first surgery yesterday--and it was brain surgery no less! I think I must have gotten lucky because from what I've heard normally the surgery rooms are packed with medical students, but they must all be on vacation or something because during the resection it was just the surgeon, two neurosurgery residents, the surgery tech who was raised on a platform to the side of the patient, the one random nurse who sat in the back and checked her email most of the time except when the surgical tech needed something, one medical student and me.

The surgery takes place in about 5 parts--first the skull gets cut open and the brain prepared for the mapping and surgery (this I didn't see). The patient is on their side, and their entire face and head except for the part that is being operated on is covered in a yellow tarp. Only the 5 X 5 inch section of the brain is exposed. Then the epileptologists come into the room (these are neurologist who specialize in the care of people with epilepsy). The surgeon attaches about 16 electrodes to the patients brain--some slide underneath the brain itself (depths), and some get put in and around the brain's sulci (subs). The electrode device looks like some contraption out of a horror movie or one of those head massage devices that have wires (I wish I could find a picture). Then, the epileptologists look at the EEG and record all the abnormal regions on the graph. In most cases, this doesn't change the surgery plan, but sometimes it does. In fact one of the residents said that this doesn't even need to be done for about 75% of the cases, but they do it for every case so that they are good at it for the 25% of the cases that do need it.

After the epileptologist has confirmed the surgery plan, the surgeon steps in and gets cutting. Yesterday's case was fairly straight forward, so the removal of the temporal lobe (the resection) took about 90 minutes. I don't now why, but I expected to see knives, but to my surprise there were none! They use these high tech tweezers things that electrically cut through tissue. 90 minutes later a piece of her brain was missing. It was very odd to see that.

Then, the epileptologists come in again and place electrodes on the brain again. To my amazement all the abnormal brain waves are gone, except for a few in new places that are due to the brain feeling agitated (these will usually disappear after the brain heals). If there was still some significant abnormal brain activity, then the surgeons might go back in again and remove some more tissue. This had to be the most amazing part to me...in just 90 minutes the brain went from abnormal to mostly normal.

I have to admit, I thought that since I am basically a nobody at this point in my career that I would be ignored, so I didn't expect much. I guess people at a teaching hospital like to teach (go figure), so without my asking several doctors took the time to show me what was going on, point out parts of the brain, etc, etc. I was also shocked by how close I was allowed to get without actually being scrubbed in (only 4 people were scrubbed in - the three surgeons and the scrub tech). The surgical resident allowed me to get within about 16 inches of the patient's brain without being scrubbed when people were scattered around the room doing other things (I had on scrubs, a face mask, little booties, and a hair cover). I guess as long as I didn't touch anyone scrubbed in, the blue tarp covering the patient then I was good...I had no idea the brain pulsated as much at it did. It's almost hard to believe that what you are seeing is real since the patient's face is covered, until you see the pulsating movement of the brain. Pretty amazing!