Week 2 - Surgery Ahoy! ....Poornima

So, this week was all about seeing my first surgeries. Monday I got to spend time in the lab and observe the research being done in Dr. Schwartz’s lab. On Tuesday I saw 3 surgeries. One involved a Laminectomy and Discectomy. From what I understood the patient had a herniated disk stressing on the spine. As the patient was suffering from Cauda equina syndrome, the disk was not placed back into its original location. Rather, they made space by removing some of the bone to remove the stress. One could not observe much as it was a small incision on the back through which Dr. Schwartz and his resident worked through. The second surgery involved a tissue biopsy and was more interesting in terms of the instruments and technique applied. The patient had a tumor deep inside the brain that couldn’t be operated. 3 tissue samples were sent to the pathologist to determine wither the tumor is malignant or benign. The striking part was that the pathology report would take 2 days, as an engineer I found that a little disturbing. Most of these surgeries didn’t last more than 2 hours, but the next surgery was almost 6 hours long. It was a stereotaxic left craniotomy for an olfactory groove meningioma and was quite big. This surgery was my highlight of the week as I got to see a wide exposed skull, a craniotomy with cool drills and instruments where they removed a small part of the skull, dura, exposed brain and more and more. The whole surgery was displayed on a screen. It was a very bloody scene but surprisingly I found myself to be quite composed. The surgeons kept cauterizing the tissue as they went deep into the brain to stop bleeding. The tumor was finally removed at the end of 4 hours. Interestingly there was also an abnormal bone growth with this tumor which was drilled out and cauterized very carefully to remove every possible trace of the tumor.The energy, patience and focus of neurosurgeons is very remarkable, something to imbibe!

Wednesday, again was lab work for me as I assisted and observed a rat craniotomy for voltage sensitive dye imaging. And then Thursday turned exciting with 2 surgeries to watch. The first patient was suffering from Pituitary adenoma. The surgical technique was an endoscopic through-the-nose type. Initially a lumbar puncture was done to assess CSF’s biochemistry and pressure. CSF was further dyed with fluorsecin by injection to detect leaks. The whole surgery was displayed on two large screens and at one point we got to see a 3D version too. That was awesome. The surgeons went through the nose, removed some of the sphenoid sinus bone and dura, made incision and removed 3-4 large pea sized tumors. Here, the surgeons were worried of a possible CSF leak and placed a fat graft to prevent it. These tumors are generally easy to distinguish. The next surgery was a subdural hematoma. CT scan showed a lot of blood localized in the whole of the left hemisphere .It was incredible to see the dura expanded like a balloon by blood inside it, applying significant pressure on the brain. A large incision in the dura and flushing out the blood was all that took to get rid of the hematoma. Moreover, this time I got to see them leaving a tube on top of the dura to drain out any bleeding. Friday was again lab day for me and learnt about recording activity from the brain using voltage sensitive dye.

To sum up, this week was very eventful in comparison to last week and I can’t wait to see what comes in the next few weeks!